Hyperthermic isolated limb perfusion (HILP) in malignant melanoma. Experience with 101 patients.
OBJECTIVE
To analyse results with a standardized HILP procedure in terms of response rate, recurrence pattern and complication rate.


METHODS
From 1992 to 2003 HILP with melphalan and dactinomycin was performed in 101 patients with loco-regional metastases of malignant melanoma of the limbs. Among these were 66 women and 35 men with a median age of 62 years. Forty patients were in M. D. Anderson stage IIIA, 51 patients in stage IIIAB and 9 had stage IV disease at the time of perfusion. If not been done before, regional lymph node dissection preceded limb perfusion in the same setting.


RESULTS
A complete response (CR) was observed in 58 out of 87 evaluable patients. Twenty-one patients achieved a partial response (PR) and eight patients were non-responders. The overall response rate was 90.8%. The median recurrence-free interval after CR was 21 months. Severe toxicity (Wieberdink IV/V) was observed in five patients necessitating fasciotomy in four of them and above knee amputation in one patient. All further cases presented with grade II-III toxicity. The overall survival was 42 months, with a 5-year survival rate of 38%. Survival significantly differed according to stage of disease.


CONCLUSIONS
HILP is an effective treatment for loco-regional tumour relapse of malignant melanoma of the extremities and has improved by modification of technique. In the absence of regional lymph node and distant metastases long-term survival can be achieved in responders.
Knorr
C
C
Department of Surgery, University Hospital of Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany. christian.knorr@chir.imed.uni-erlangen.de
Meyer
T
T
Janssen
T
T
Goehl
J
J
Hohenberger
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects / Q000379:methods; D003609:Dactinomycin / Q000008:administration & dosage; D005121:Extremities / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology; D013514:Surgical Procedures, Operative; D016019:Survival Analysis; D016896:Treatment Outcome
D003609:Dactinomycin; D008558:Melphalan