Elsevier

European Journal of Cancer

Volume 100, September 2018, Pages 46-54
European Journal of Cancer

Original Research
The effect of age on outcomes after isolated limb perfusion for advanced extremity malignancies

https://doi.org/10.1016/j.ejca.2018.04.014Get rights and content
Under a Creative Commons license
open access

Highlights

  • Isolated limb perfusion is technically feasible in the majority of patients aged >75 years.

  • Rates of locoregional toxicity are comparable between older and younger patients.

  • Response rates remain high (60–80%) in those aged >75 years.

Abstract

Background

Isolated limb perfusion (ILP) is a well-established treatment for patients with advanced extremity malignancies unsuitable for limb-conserving surgery. However, little is known about the outcomes of this treatment in elderly patients. We sought to determine the effects of age on the tolerability and efficacy of ILP for advanced extremity malignancy.

Patients and methods

Patients undergoing ILP at our institution between January 2005 and January 2018 were identified from a prospectively maintained database. Patients were stratified by pathology (melanoma, soft-tissue sarcoma, other) and age (<75 years and ≥75 years). Outcomes of interest were perioperative morbidity and mortality, locoregional toxicities, response rates and oncological outcomes.

Results

During the study period, a total of 189 perfusions were attempted. Successful perfusions were performed in 179 patients, giving a technical success rate of 94.7%. No difference in perfusion success rates, severe locoregional toxicity and perioperative morbidity or mortality was noted between those aged <75 years and ≥75 years. The overall response rate in melanoma was 82.4%, and no difference in response rates or oncological outcomes between age groups was noted in these patients. The overall response rate in soft-tissue sarcoma was 63.5%, with no difference in response rates noted between age groups. However, patients aged <75 years with soft-tissue sarcoma had prolonged local recurrence-free survival compared with older patients (13 versus 6 months), possibly due to the prevalence of chemosensitive subtypes in the younger age group.

Conclusion

ILP is an effective treatment for advanced extremity malignancies in the elderly, with comparable response rates and toxicities to younger patients.

Keywords

Soft-tissue sarcoma
Melanoma
Isolated limb perfusion
Geriatric oncology

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