title: Isolated Limb Perfusion for Melanoma is Safe and Effective in Elderly Patients.
abstract: BACKGROUND
  Data on isolated limb perfusion (ILP) in elderly melanoma patients are scarce. We aimed to evaluate the efficacy and safety of ILP in our institutional cohort of melanoma patients.
  
  
  METHODS
  We performed retrospective analysis of stage IIIB/C melanoma patients who underwent ILP for melanoma in-transit metastases (ITMs) in our institution between 2000 and 2016. Normothermic ILP was performed with either melphalan or melphalan and tumor necrosis factor. Baseline and treatment characteristics, locoregional progression-free survival (LPFS) and melanoma-specific survival (MSS) were assessed and prognostic factors for response, recurrence, and survival were analyzed using univariable and multivariable analysis.
  
  
  RESULTS
  Overall, 91 patients were included in this study. Based on the median age of 70 years, we split patients into younger and elderly groups. No differences in response rates were observed between age groups, with an overall response rate of 81% and complete response (CR) rate of 47%. LPFS did not differ between age groups, and median LPFS was 16 months for patients with a CR. Median MSS was 38 months and differed between younger (45 months) and elderly patients (18 months). Toxicity was generally mild and did not differ between age groups. Two patients (2.2%) suffered Wieberdink IV toxicity, while no patients required amputation because of severe toxicity. CR was prognostic for improved LPFS and MSS, while patients >70 years of age and patients with stage IIIC disease had a higher risk of melanoma-specific death.
  
  
  CONCLUSIONS
  Because of its safety profile and high CR rates, ILP is a viable option for patients with bulky or multiple melanoma ITMs, including elderly (>70 years of age) patients.
authors.affiliation: Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors.forename: Max F
authors.initials: MF
authors.lastname: Madu
authors.affiliation: Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors.forename: Marion M
authors.initials: MM
authors.lastname: Deken
authors.affiliation: Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors.forename: Jos A
authors.initials: JA
authors.lastname: van der Hage
authors.affiliation: Department of Epidemiology and Biostatistics, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Jóźwiak
authors.affiliation: Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors.forename: Michel W J M
authors.initials: MWJM
authors.lastname: Wouters
authors.affiliation: Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands. a.v.akkooi@nki.nl.
authors.forename: Alexander C J
authors.initials: ACJ
authors.lastname: van Akkooi
mesh_terms: D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D005121:Extremities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000098:blood supply / Q000188:drug therapy* / Q000473:pathology; D008558:Melphalan / Q000008:administration & dosage*; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000098:blood supply / Q000188:drug therapy* / Q000473:pathology; D061214:Patient Safety; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan