title: Isolated limb infusion as palliative treatment for advanced limb disease in patients with AJCC stage IV melanoma.
abstract: BACKGROUND
  In the treatment of patients with advanced limb melanoma a major treatment dilemma can arise when distant metastases are present also. Isolated limb infusion (ILI) has proved to be a useful limb-saving treatment and could potentially be of palliative value in patients with American Joint Committee on Cancer (AJCC) stage IV melanoma.
  
  
  METHODS
  We identified 37 patients with advanced symptomatic limb disease as well as documented distant metastases at the time of their ILI. In all patients a drug combination of melphalan and actinomycin D was used.
  
  
  RESULTS
  Fifty one percent had visceral distant metastases and 49% had cutaneous distant metastases only. The overall response rate in the treated limb was 76% [complete response (CR) rate 22%, partial response (PR) rate 54%]. Median response duration was 11 months (28 months for patients with CR; p = 0.08). Median survival after CR was 22 months, 17 months after PR, and only 4 months for those with stable or progressive disease (p = 0.002). Patients with visceral distant metastases had a significantly decreased survival compared with those with cutaneous distant metastases only (8 and 21 months, respectively; p = 0.03). Limb salvage was achieved in 86% of the patients. The procedure was well tolerated, with only one patient developing Wieberdink grade IV toxicity (threatened/actual compartment syndrome) and none requiring amputation as a result of the procedure (grade V toxicity).
  
  
  CONCLUSIONS
  Minimally invasive ILI can effectively be used as palliative treatment to provide local tumor control and limb salvage in stage IV melanoma patients with advanced, symptomatic limb disease.
authors.affiliation: Sydney Melanoma Unit and Melanoma Institute Australia, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia.
authors.forename: Hidde M
authors.initials: HM
authors.lastname: Kroon
authors.forename: D-Yin
authors.initials: DY
authors.lastname: Lin
authors.forename: Peter C A
authors.initials: PC
authors.lastname: Kam
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D010478:Chemotherapy, Cancer, Regional Perfusion; D003609:Dactinomycin / Q000008:administration & dosage; D005121:Extremities; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008545:Melanoma / Q000188:drug therapy*; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D012878:Skin Neoplasms / Q000188:drug therapy*
chemical_list: D003609:Dactinomycin; D008558:Melphalan