title: Australian multi-center experience outside of the Sydney Melanoma Unit of isolated limb infusion chemotherapy for melanoma.
abstract: BACKGROUND
  Isolated limb infusion (ILI) is a minimally invasive alternative to isolated limb perfusion (ILP) for delivering high-dose regional chemotherapy to treat locally advanced limb melanoma. The current study aimed to evaluate the applicability of ILI in four Australian tertiary referral centers outside of its originating institution, the Sydney Melanoma Unit (SMU; currently known as the Melanoma Institute Australia).
  
  
  METHODS
  Data of 131 patients, treated between 1992 and 2008 were collectively analyzed. The ILI procedures were based on the Sydney Melanoma Unit protocol using melphalan. Response was determined using the WHO criteria and toxicity was assessed using the Wieberdink scale.
  
  
  RESULTS
  The median patient age was 74 years (range 28-100). Fifty-six percent were female. Overall response (OR) rate to ILI was 63% (CR 27%; PR 36%). Wieberdink toxicity grade III or higher was seen in 13%. No toxicity-related amputations occurred. Median follow-up was 24 months; median survival was 58 months. In patients with a complete response (CR), median survival was 101 months; in patients with a partial response (PR) this was 41 months (P = 0.026). On univariate analysis a younger age, lower-limb procedures and a lower Breslow thickness of the primary melanoma were associated with a favorable response. On multivariate analysis Breslow thickness and lower-limb ILI remained significant predictors for response.
  
  
  CONCLUSIONS
  In this, to date, largest multi-center study of ILI for melanoma the results are comparable to other reports and demonstrate that ILI can be widely implemented and safely applied across tertiary referral centers.
authors.affiliation: Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Brendon J
authors.initials: BJ
authors.lastname: Coventry
authors.forename: Hidde M
authors.initials: HM
authors.lastname: Kroon
authors.forename: Mitchell H
authors.initials: MH
authors.lastname: Giles
authors.forename: Michael
authors.initials: M
authors.lastname: Henderson
authors.forename: David
authors.initials: D
authors.lastname: Speakman
authors.forename: Mark
authors.initials: M
authors.lastname: Wall
authors.forename: Andrew
authors.initials: A
authors.lastname: Barbour
authors.forename: Jonathan
authors.initials: J
authors.lastname: Serpell
authors.forename: Paul
authors.initials: P
authors.lastname: Paddle
authors.forename: Alexander G J
authors.initials: AG
authors.lastname: Coventry
authors.forename: Thomas
authors.initials: T
authors.lastname: Sullivan
authors.forename: B Mark
authors.initials: BM
authors.lastname: Smithers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001315:Australia; D010478:Chemotherapy, Cancer, Regional Perfusion; D005121:Extremities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015996:Survival Rate
keywords: chemotherapy; isolated limb infusion; metastatic melanoma