title: Regional hyperthermic perfusion with cisplatin following surgery for malignant melanoma of the extremities.
abstract: BACKGROUND
  The study was undertaken to review our experience in the treatment of extremity melanoma with hyperthermic isolated limb perfusion (HILP), using cisplatin as the chemotherapeutic agent. We also evaluated the best timing for regional lymph node dissection in relation to the perfusion.
  
  
  METHODS
  Sixty patients with advanced malignant melanoma of the limbs were treated with HILP used mainly as an adjuvant treatment. There were 56 lower- and 4 upper-limb HILPs. Cisplatin was used at a dose of 20 mg/L of limb volume. Temperature at the tumor site was 39 degrees C to 40 degrees C. Postoperative complications, disease-free period, and time to recurrence were recorded.
  
  
  RESULTS
  There were no deaths related to the procedure. Forty-seven percent of the patients developed local complications; most complications were minor and resolved within 60 days. The local complication rate was higher when HILP was performed shortly after or simultaneously with regional lymph node dissection. None of the patients had systemic complications. Mean survival time from treatment was 87.2 months. Currently, 35 patients (58%) are alive and free of disease 52.7 +/- 22.5 months after HILP. Twelve patients (20%) are alive with recurrent disease, of which 5 recurred locally. The average time (+/- standard error of the mean) to recurrence was 24.5 +/- 13.8 months after perfusion.
  
  
  CONCLUSIONS
  HILP with cisplatin is a relatively safe procedure, which seems to increase locoregional control of advanced malignant melanoma of the extremity. Separating the timing of lymph node dissection from HILP by 6 to 8 weeks reduces the complication rate.
authors.affiliation: Department of Surgical Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: M Z
authors.initials: MZ
authors.lastname: Papa
authors.forename: E
authors.initials: E
authors.lastname: Klein
authors.forename: T
authors.initials: T
authors.lastname: Karni
authors.forename: M
authors.initials: M
authors.lastname: Koller
authors.forename: B
authors.initials: B
authors.lastname: Davidson
authors.forename: E
authors.initials: E
authors.lastname: Azizi
authors.forename: G
authors.initials: G
authors.lastname: Ben-Ari
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D010478:Chemotherapy, Cancer, Regional Perfusion; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005121:Extremities; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008197:Lymph Node Excision; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011182:Postoperative Care; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin