title: Australian Multicenter Study of Isolated Limb Infusion for Melanoma.
abstract: OBJECTIVE
  Isolated limb infusion (ILI) offers a less invasive alternative to isolated limb perfusion (ILP) for the treatment of locally advanced extremity melanoma. In Australia, ILI has essentially completely replaced ILP. The aim of this study was to collect and evaluate the results of ILI in an Australian multicenter setting.
  
  
  METHODS
  The results of 316 first ILI procedures, performed between 1992 and 2008 in five Australian institutions, were collectively analyzed, with all five institutions using the same protocol. Melphalan was circulated in the isolated limb for 20-30 min (±actinomycin D). Response was determined using the World Health Organization criteria, and limb toxicity was assessed using the Wieberdink scale.
  
  
  RESULTS
  The median patient age was 74 years (range 28-100) and 59 % of patients were female. Overall response rate was 75 % (complete response [CR] 33 %; partial response 42 %). Stable disease was seen in 18 % of patients and progressive disease in 7 %. Wieberdink grade III or higher was seen in 30 % of the cases. No toxicity-related amputations occurred, and median survival was 44 months. In patients with a CR, median survival was 80 months (p = 0.014). On multivariate analysis, Breslow thickness, lower-limb ILI, and a procedure performed at the Melanoma Institute Australia remained significant predictors for response, although not for survival.
  
  
  CONCLUSIONS
  This Australian multicenter study of ILI is the largest reported to date. ILI is a useful technique that can be safely and effectively performed across tertiary referral centers for the successful management of advanced extremity melanoma. Increased optimization of perioperative factors might allow response rates to be raised further, while maintaining acceptable toxicity.
authors.affiliation: Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia. hmkroon@hotmail.com.|Melanoma Institute Australia, Sydney, NSW, Australia. hmkroon@hotmail.com.
authors.forename: Hidde M
authors.initials: HM
authors.lastname: Kroon
authors.affiliation: Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia. brendon.coventry@adelaide.edu.au.
authors.forename: Brendon J
authors.initials: BJ
authors.lastname: Coventry
authors.affiliation: Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Mitchell H
authors.initials: MH
authors.lastname: Giles
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Henderson
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Speakman
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Wall
authors.affiliation: Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Barbour
authors.affiliation: Discipline of Surgery, The Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Serpell
authors.affiliation: Discipline of Surgery, The Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Paddle
authors.affiliation: Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Alexander G J
authors.initials: AG
authors.lastname: Coventry
authors.affiliation: Statistics, Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Sullivan
authors.affiliation: Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia.
authors.forename: Bernard Mark
authors.initials: BM
authors.lastname: Smithers
authors.affiliation: Melanoma Institute Australia, Sydney, NSW, Australia.|Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia.|Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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 / Q000627:therapeutic use*; D001315:Australia; D010478:Chemotherapy, Cancer, Regional Perfusion; D003609:Dactinomycin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D015996:Survival Rate
chemical_list: D003609:Dactinomycin; D008558:Melphalan