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Thursday July 21, 2011
Results of a recent study highlight the improvement in outcome of isolated limb infusion therapy (ILI) that are due to protocol changes and increased experience. The study compared the outcomes of ILI undertaken at Melanoma Institute Australia (MIA) during two treatment periods. These findings have important relevance to New Zealand, as MelNet has highlighted to the Ministry of Health the need for a national approach to limb infusion therapy for New Zealand patients.
As explained by the study authors, since the late 1950’s, patients with unresectable melanoma confined to a limb have been treated by a technique known as isolated limb perfusion (ILP). This “remarkably effective” procedure allows a high dose of regional chemotherapy to be administered without causing serious systemic side-effects. Major disadvantages are that it is complex, expensive and invasive.
As outlined in the article, a simplified and minimally invasive procedure called isolated limb infusion (ILI) was developed and introduced at Melanoma Institute Australia (formerly the Sydney Melanoma Unit) in the early 1990s with the aim of achieving the benefits of ILP without involving its major disadvantages. According to the authors, ILI has subsequently been proved to be a safe and effective procedure with results similar to those achieved after ILP but with less morbidity.
The study involved comparing the outcomes of ILI for melanoma during two treatment periods at the MIA. As far as the authors are aware, this is the first study to compare the outcomes of ILI for melanoma during two treatment periods at a single institution.
The aim of the study was to evaluate whether the changes that have been made to the ILI protocol and the institution’s increased experience with the technique had
an effect on results and toxicity. For this purpose the authors examined data for patients treated with a single ILI at MIA during an early period (1992–1999) and a later period (2000–2007).
As outlined in the abstract, the patient characteristics of the early and late groups were similar. However, there was greater tumour load in the late group, who had a significantly greater number of lesions and deeper tumour infiltration. Drug circulation times were longer in the late group, and higher initial and final limb temperatures were achieved in this group. The late group also showed a trend towards less toxicity.
The authors conclude that “improvement in outcome over two periods can be explained by the modifications that have been made to the ILI protocol over time, based on research performed previously and increased experience with the ILI technique”.
Huismans AM, Kroon HM, Kam PCA, Thompson JF. Does Increased Experience with Isolated Limb Infusion for Advanced Limb Melanoma Influence Outcome? A Comparison of Two Treatment Periods at a Single Institution. Ann Surg Oncol (2011) 18:1877–1883. DOI 10.1245/s10434-011-1646-y