title: A multi-institutional experience of repeat regional chemotherapy for recurrent melanoma of extremities.
abstract: BACKGROUND
  Hyperthermic isolated limb perfusion (HILP) or isolated limb infusion (ILI) are well-accepted regional chemotherapy techniques for in-transit melanoma of extremity. The role and efficacy of repeat regional chemotherapy for recurrence and which salvage procedure is better remains debatable. We aimed to compare toxicities and clinical outcomes by procedure types and the sequence.
  
  
  METHODS
  Data from 44 patients, who underwent repeat HILPs or ILIs from 3 institutions beginning 1997 to 2010, were retrospectively reviewed. Regional toxicity assessed by Wieberdink grade, systemic toxicity assessed by serum creatine phosphokinase level, length of hospital stay (LOS), response rates at 3 months after the procedure, and time to in-field progression (TTP) were analyzed.
  
  
  RESULTS
  Of 44 patients, 46% were men and 54% women with a median age of 66 (range 29-85) years at diagnosis. The median follow-up was 21.4 (range 4-153) months. Of 70 ILIs and 28 HILPs, the following groups were identified: group A, ILI → ILI (n = 25); group B, ILI → HILP (n = 10); group C, HILP → ILI (n = 12); and group D, HILP → HILP (n = 3). The comparison of Wieberdink grade, serum creatine phosphokinase level, LOS, and response rate between procedures (HILP vs. ILI), between sequence (initial vs. repeat), and among their interactions showed no statistically significant differences. TTP after initial procedure did not differ between HILP and ILI (P = 0.08), and no survival difference was seen (P = 0.65) when TTP after repeat procedure was compared.
  
  
  CONCLUSIONS
  Most patients tolerated repeat regional chemotherapy without increased toxicity or LOS. No statistical difference in clinical outcomes was noted when comparing repeat procedures, even though repeat HILPs showed higher complete response compared to repeat ILIs.
authors.affiliation: Department of Surgery, San Antonio Military Medical Center, San Antonio, TX, USA.
authors.forename: Christy Y
authors.initials: CY
authors.lastname: Chai
authors.forename: Jeremiah L
authors.initials: JL
authors.lastname: Deneve
authors.forename: Georgia M
authors.initials: GM
authors.lastname: Beasley
authors.forename: Suroosh S
authors.initials: SS
authors.lastname: Marzban
authors.forename: Y Ann
authors.initials: YA
authors.lastname: Chen
authors.forename: Bhupendra
authors.initials: B
authors.lastname: Rawal
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Grobmyer
authors.forename: Steven N
authors.initials: SN
authors.lastname: Hochwald
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion; D003609:Dactinomycin / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology; D008558:Melphalan / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D003609:Dactinomycin; D008558:Melphalan