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Isolated limb perfusion for in‐transit melanoma metastases: Melphalan or TNF‐melphalan perfusion?
Author(s) -
Hoekstra Harald J.,
Veerman Kelly,
van Ginkel Robert J.
Publication year - 2014
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23552
Subject(s) - melphalan , medicine , melanoma , perfusion , stage (stratigraphy) , chemotherapy , surgery , gastroenterology , cancer research , paleontology , biology
Indications for treatment of melanoma in‐transit metastases (ITMs) confined to the limb with isolated limb perfusion (ILP) are not well defined. This study reports the Groningen regional therapeutic perfusion experience with melphalan (M‐ILP) and TNF‐melphalan (TM‐ILP) for ITMs, and reviews of the melanoma TNF‐melphalan ILP literature. Between 1991 and 2012, 60 patients were treated with ILP. Patients with “small” ITMs received M‐ILP (10–13 mg melphalan/L limb volume) and patients with “bulky” disease TM‐ILP (1–4 mg TNF); 19 M‐ILPs and 41 TM‐ILPs were performed, 26 Stage IIIB, 31 Stage IIIB and 1 stage IV disease. Overall response after 57 ILPs was 90%; CR 27 (45%), PR 27 (45%), no response 3 (5%); after 9 M‐ILPs CR 6 (32%) and 41 TM‐ILPs CR 21 (51%, P = 0.124). For younger patients (<65 years) CR was 69% and for elderly patients 29% ( P = 0.003). For low volume disease (<5 ITMs) CR was 75% and for high volume disease (≥5 ITMs) 41% ( P = 0.038). After median follow‐up of 15 months (range, 1–144) there was local recurrence or disease progression in 36 patients (60%). Positive lymph node status was associated with local progression, absence of CR and Stage IIIC disease; these were independent prognostic factors for progression to systemic disease. M‐ILP is an effective regional treatment for melanoma ITMs, whereas for bulky disease TM‐ILP should be the first choice. In‐field progression‐free survival after ILP is determined by the biological behavior of the ITMs and the patient's immune system. J. Surg. Oncol. 2014 109:338–347 . © 2014 Wiley Periodicals, Inc.