Long-term outcome of hyperthermic isolated limb perfusion (HILP) in the treatment of locoregionally metastasised malignant melanoma of the extremities.
OBJECTIVE
The aim is to analyse a modified standardised HILP procedure regarding the response rates, local recurrences and complication rates.


METHODS
152 patients (101 females, 51 males) with an average age of 62 years and locoregionally metastasised malignant melanoma underwent HILP using melphalan and dactinomycin between 1992 and 2007. Using M.D. Anderson's classification at the time of the perfusion 51 patients presented in stage IIIA, 43 patients in stage IIIAB and 58 patients in stage IV. If indicated, lymph node dissection was performed simultaneously just before perfusion of the extremity.


RESULTS
Complete remission was observed in 91 (62.7%) of 145 patients, partial remission in 26 (17.9%) patients. 28 (19.3%) patients showed no response. The overall response rate was 80.7% (117 of 145 patients). Severe complications (Wieberdink IV/V) were seen in eight cases. The average recurrence-free survival was 17 months. The median survival was 39 months; the five-year overall survival rate was 38%. The overall survival rate was significantly influenced by the stage of the disease.


CONCLUSIONS
HILP is an efficient therapy for multiple or recurrent in-transit metastases of malignant melanoma of the lower extremities. The efficiency increased by improving the technique of the perfusion. Long-term survival can be observed in patients without regional lymph node metastases or distant metastases.
Boesch
Cedric E
CE
Department of General Surgery, University Medical Centre Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
Meyer
Thomas
T
Waschke
Lena
L
Merkel
Susanne
S
Goehl
Jonas
J
Hohenberger
Werner
W
Knorr
Christian
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects / Q000379:methods*; D003609:Dactinomycin / Q000008:administration & dosage; D005121:Extremities / Q000473:pathology; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects / Q000379:methods*; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000628:therapy*; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000628:therapy*; D012878:Skin Neoplasms / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
D003609:Dactinomycin; D008558:Melphalan