title: A randomized controlled trial of prophylactic isolated cytotoxic perfusion for poor-prognosis primary melanoma of the lower limb.
abstract: A randomized controlled trial of prophylactic isolated hyperthermic limb perfusion (IHLP) using melphalan at 2 mg/kg body weight has been performed on a total of 30 patients with primary melanoma of the lower limb > or = 1.7 mm thick. Excision (control, n = 14) was compared to excision plus IHLP (n = 16). The two groups were well matched for sex, tumour thickness and duration of follow-up (control group median: 63 months (range: 16-108), perfusion group median: 80 months (range: 37-113)). Recurrent disease developed in nine of the control group, seven of whom have died. In the perfusion group only two patients have developed recurrent disease, both of whom have died (recurrence: P < 0.004, mortality: P < 0.03, using Fishers' exact probability test). Inguino-femoral nodal recurrence occurred in five of nine control patients, but in only one patient in the perfusion group. These data support the use of adjuvant IHLP in the management of poor-prognosis primary melanoma of the lower limb.
authors.affiliation: University Department of Surgery, University of Wales College of Medicine, Health Park, Cardiff, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Fenn
authors.forename: K
authors.initials: K
authors.lastname: Horgan
authors.forename: R C
authors.initials: RC
authors.lastname: Johnson
authors.forename: L E
authors.initials: LE
authors.lastname: Hughes
authors.forename: R E
authors.initials: RE
authors.lastname: Mansel
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007866:Leg; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan