Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, Australia.
Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia.
Eur J Surg Oncol. 2019 May;45(5):832-837. doi: 10.1016/j.ejso.2019.02.026. Epub 2019 Feb 27.
Isolated limb infusion (ILI) is a minimally invasive treatment for patients with locally advanced extremity melanoma. Most studies combine results of upper-limb ILI (UL-ILI) and lower-limb ILI (LL-ILI), leaving UL-ILIs relatively underreported as LL-ILIs comprise the vast majority in these reports. However, differences between the two procedures may be clinically important. The aim of this study was to evaluate the efficacy and toxicity of UL-ILI in an Australian multi-center setting.
316 ILI procedures for melanoma performed between 1992 and 2008 in five Australian institutions were analyzed. In all institutions melphalan (±actinomycin D) was circulated in the isolated limb for 20-30 min.
Baseline patient characteristics for UL-ILI (n = 27) and LL-ILI (n = 289) were similar, except that more men underwent UL-ILI (66% vs. 38%; p = 0.007) and disease in LL-ILI was mostly located on the distal limb (p = 0.02). Median tourniquet times were shorter for UL-ILI (38 vs. 48 min; p = 0.04) and UL-ILI patients experienced less limb toxicity (Grade III/IV in 24% vs. 31%; p = 0.01). Complete response (CR) rates were similar: 33% after LL-ILI (p = 0.70), 30% after UL-ILI, while overall response (OR) rates were higher after LL-ILI: (76%) than UL-ILI (59%; p = 0.05). No difference in survival was seen.
UL-ILI is safe to perform and effective, resulting in low limb toxicity. CR rates were similar to those for LL-ILI, but OR rates were lower for UL-ILI. It may be possible to improve OR rates achieved by UL-ILI by optimizing perioperative factors, while maintaining low toxicity.
孤立肢体灌注（ILI）是一种治疗局部晚期肢体黑色素瘤的微创方法。大多数研究将上肢 ILI（UL-ILI）和下肢 ILI（LL-ILI）的结果结合在一起，由于这些报告中绝大多数是 LL-ILI，因此 UL-ILI 的报告相对较少。然而，这两种手术之间的差异可能具有临床意义。本研究旨在评估在澳大利亚多中心环境下 UL-ILI 的疗效和毒性。
分析了 1992 年至 2008 年间在澳大利亚的五个机构中进行的 316 例黑色素瘤 ILI 手术。在所有机构中，长春新碱（±放线菌素 D）在孤立肢体中循环 20-30 分钟。
UL-ILI（n=27）和 LL-ILI（n=289）的基线患者特征相似，除了更多的男性接受 UL-ILI（66% vs. 38%；p=0.007），并且 LL-ILI 中的疾病主要位于远端肢体（p=0.02）。UL-ILI 的止血带时间更短（38 对 48 分钟；p=0.04），UL-ILI 患者的肢体毒性更小（3/4 级 24% vs. 31%；p=0.01）。完全缓解（CR）率相似：LL-ILI 后为 33%（p=0.70），UL-ILI 后为 30%，而总缓解（OR）率在 LL-ILI 后更高：（76%）高于 UL-ILI（59%；p=0.05）。未观察到生存差异。
UL-ILI 安全有效，导致低肢体毒性。CR 率与 LL-ILI 相似，但 UL-ILI 的 OR 率较低。通过优化围手术期因素，同时保持低毒性，可能提高 UL-ILI 获得的 OR 率。
