Isolated limb perfusion for unresectable melanoma of the extremities.
OBJECTIVE
In patients with truly unresectable melanoma of the extremities, results after isolated limb perfusion (ILP) are absent in the literature. Complete response rates are probably lower than the reported 54% for locoregional recurrent melanoma. In these patients, ILP with melphalan and tumor necrosis factor alpha (TNF-alpha) could be superior to ILP with melphalan alone.


METHODS
Retrospective analysis with a median follow-up period of 21 months (interquartile range, 9-40 months).


METHODS
Two tertiary care cancer centers in the Netherlands.


METHODS
We assessed all 130 consecutive patients who underwent ILP for unresectable melanoma of the extremities, performed between 1978 and 2001. Of these patients, 38% had stage IIIA melanoma and 45% had stage IIIAB melanoma according to criteria of the MD Anderson Cancer Center. Lesions were considered unresectable on the basis of their size, number, or localization.


METHODS
Forty ILPs were performed with melphalan, and 90 were done with TNF-alpha and melphalan.


METHODS
Response rate, disease-free survival, limb salvage rate, and overall survival.


RESULTS
In 45% of the patients, a complete response was attained after ILP with melphalan (95% confidence interval, 29%-61%) compared with 59% after ILP with TNF-alpha and melphalan (95% confidence interval, 49%-69%; P = .14). The time to complete response was 3 months (interquartile range, 2-6 months) vs 2 months (interquartile range, 1-3 months; P = .01), respectively. The recurrence rate and median limb recurrence-free survival were not significantly different for both ILP types. The overall limb salvage rate was 96%. Overall 5-year survival was 29% (95% confidence interval, 20%-38%). The ILP type was not an independent prognostic factor for complete response, nor was limb recurrence-free survival, whereas stage IIIA was a favorable prognostic factor (P = .01 and P = .02, respectively). Favorable prognostic factors for improved survival were complete response (P<.001) and a tumor size of 3 cm or less (P = .01).


CONCLUSIONS
In more than half of the patients with truly unresectable melanoma of the extremities, a complete response was obtained after ILP with melphalan with or without TNF-alpha. The ILP type was not an independent prognostic factor for complete response, limb recurrence-free survival, or overall survival.
Noorda
Eva M
EM
Department of Surgery, The Netherlands Cancer Institute and Antoni van Leeuwenhoek Hospital, Amsterdam. em_noorda@yahoo.com
Vrouenraets
Bart C
BC
Nieweg
Omgo E
OE
van Geel
Bert N
BN
Eggermont
Alexander M M
AM
Kroon
Bin B R
BB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D005121:Extremities; D005260:Female; D006801:Humans; D023821:Limb Salvage / Q000379:methods; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000628:therapy*; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage
D000970:Antineoplastic Agents; D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan