Efficacy of hyperthermic isolated limb perfusion for extremity-confined recurrent melanoma.
BACKGROUND
Recurrent melanoma of the extremity has been treated by local excision, systemic chemotherapy, amputation, or a combination of these approaches. Hyperthermic isolated limb perfusion (HILP) provides a method of limb preservation through isolation, allowing the administration of chemotherapy in higher doses than is possible through systemic treatment.


METHODS
An experimental group of 59 HILP patients with melanoma recurrences of the extremity was studied prospectively. A control group of 248 melanoma patients with similar recurrences was excluded from HILP because their recurrences were in non-extremity locations. The experimental group underwent HILP and excision; the control group had excision only. The experimental procedure consisted of vascular isolation of the affected extremity and a 1-hour perfusion with melphalan. Temperatures were maintained at 40 degrees C in the perfusion circuit.


RESULTS
The HILP patients had a lower rate of locoregional recurrence (P=.028) and demonstrated increased survival (P=.026) compared to the control group. In multivariate regression analysis, which included age, ulceration and thickness of the primary, and the treatment variable of perfusion, age (P=.02) and perfusion for the treatment of recurrence (P=.006) were significant predictors of survival.


CONCLUSIONS
HILP improves prognosis by sterilizing the treated extremity, controlling locoregional disease, and perhaps preventing metastasis, thus having a positive impact on overall survival.
Brobeil
A
A
Cutaneous Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa 33612-9497, USA.
Berman
C
C
Cruse
C W
CW
De Conti
R
R
Cantor
A
A
Lyman
G H
GH
Joseph
E
E
Rapaport
D
D
Wells
K
K
Reintgen
D S
DS
D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D005121:Extremities; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008545:Melanoma / Q000556:secondary* / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D010477:Perfusion / Q000379:methods*; D011446:Prospective Studies; D016019:Survival Analysis
D000970:Antineoplastic Agents