TY - JOUR

T1 - Tumour response after hyperthermic isolated limb perfusion for locally advanced melanoma

AU - Paulsen, Ida Felbo

AU - Chakera, A H

AU - Drejøe, Jennifer Berg

AU - Klyver, Helle

AU - Dahlstrøm, Karin

AU - Oturai, Peter Sandor

AU - Mortensen, Jann

AU - Hesse, Birger

AU - Schmidt, Grethe

AU - Drzewiecki, Krzysztof

PY - 2014/1

Y1 - 2014/1

N2 - INTRODUCTION: The aim was to describe tumour response, complications, recurrence and survival after hyperthermic isolated limb perfusion (ILP) with melphalan or melphalan in combination with tumour necrosis factor-alpha in patients with melanoma metastases confined to an extremity.MATERIAL AND METHODS: A total of 84 perfusions were performed (53 women, 31 men, median age 63 years) from 1993 to 2010. 95% of the perfusions were administered to the lower limbs and 5% to the upper limbs. The inclusion criteria were recurrent and/or clinically apparent cutaneous/subcutaneous extremity in-transit melanoma metastases.RESULTS: The response rate after ILP was 85%; 42% had complete response (CR), 43% partial response (PR), 12% no change (NC) and 3% progression. Two- and five-year survival rates were 57% and 31%, respectively, and they were higher for patients with than without lymph node metastases. Time from ILP to recurrence was a median of seven months (range 1-37 months) for patients with CR or PR. Survival was longer for patients with CR or PR than for patients showing NC or progression. Several patients had mild or moderate local toxicity reactions, two patients developed severe local toxicity.CONCLUSION: ILP induces tumour regression in the vast majority of patients. One patient, i.e. 1% of the group, died from surgical complications. Otherwise, ILP treatment had an acceptable morbidity in this group of very sick patients. We are convinced that the treatment should be offered to improve local disease control in patients with multiple and/or recurrent melanoma confined to an extremity if surgical excision is not possible.FUNDING: not relevant.TRIAL REGISTRATION: not relevant.

AB - INTRODUCTION: The aim was to describe tumour response, complications, recurrence and survival after hyperthermic isolated limb perfusion (ILP) with melphalan or melphalan in combination with tumour necrosis factor-alpha in patients with melanoma metastases confined to an extremity.MATERIAL AND METHODS: A total of 84 perfusions were performed (53 women, 31 men, median age 63 years) from 1993 to 2010. 95% of the perfusions were administered to the lower limbs and 5% to the upper limbs. The inclusion criteria were recurrent and/or clinically apparent cutaneous/subcutaneous extremity in-transit melanoma metastases.RESULTS: The response rate after ILP was 85%; 42% had complete response (CR), 43% partial response (PR), 12% no change (NC) and 3% progression. Two- and five-year survival rates were 57% and 31%, respectively, and they were higher for patients with than without lymph node metastases. Time from ILP to recurrence was a median of seven months (range 1-37 months) for patients with CR or PR. Survival was longer for patients with CR or PR than for patients showing NC or progression. Several patients had mild or moderate local toxicity reactions, two patients developed severe local toxicity.CONCLUSION: ILP induces tumour regression in the vast majority of patients. One patient, i.e. 1% of the group, died from surgical complications. Otherwise, ILP treatment had an acceptable morbidity in this group of very sick patients. We are convinced that the treatment should be offered to improve local disease control in patients with multiple and/or recurrent melanoma confined to an extremity if surgical excision is not possible.FUNDING: not relevant.TRIAL REGISTRATION: not relevant.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Antineoplastic Agents

KW - Antineoplastic Combined Chemotherapy Protocols

KW - Chemotherapy, Cancer, Regional Perfusion

KW - Combined Modality Therapy

KW - Disease Progression

KW - Extremities

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Hyperthermia, Induced

KW - Lymphatic Metastasis

KW - Male

KW - Melanoma

KW - Melphalan

KW - Middle Aged

KW - Prospective Studies

KW - Skin Neoplasms

KW - Survival Rate

KW - Treatment Outcome

KW - Tumor Necrosis Factor-alpha

M3 - Journal article

C2 - 24393586

VL - 61

JO - Danish Medical Journal

JF - Danish Medical Journal

SN - 2245-1919

IS - 1

M1 - A4741

ER -