title: Isolated limb perfusion for melanoma in-transit metastases: developments in recent years and the role of tumor necrosis factor alpha.
abstract: OBJECTIVE
  The treatment of in-transit metastasis of melanoma remains challenging and is essentially dictated by the biological behavior of melanoma. When lesions are large or numerous, isolated limb perfusion (ILP) is an attractive treatment modality. In this review an overview of literature on treatment options of melanoma in-transit metastases will be discussed.
  
  
  RESULTS
  Most recent studies report on tumor necrosis factor (TNF) and melphalan based ILP (TM-ILP) series or mixed series of TM-ILP and melphalan only based ILP (M-ILP). After TM-ILP complete response rates of 70% (range 44-90%) have been reported, while for M-ILP this is lower with complete response rates of 54% (range 40-76%). The only randomized trial comparing TM-ILP and M-ILP revealed no clear benefit of TNF at 3 months, but improved outcome at 6 months and in patients with bulky disease. Reports on isolated limb infusion (ILI) with melphalan and actinimycin D indicate lower response rates, but similar local control rates as M-ILP at lower cost.
  
  
  CONCLUSIONS
  ILP is an attractive treatment option in melanoma patients with multiple in-transit metastases. In our opinion TM-ILP is superior to M-ILP as it achieves higher response rates, especially in patients with bulky disease. When lesions are small and in the distal two-thirds of the leg only, ILI is a valuable alternative.
authors.affiliation: Department of Surgical Oncology, Daniel den Hoed Cancer Centre, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Jan P
authors.initials: JP
authors.lastname: Deroose
authors.forename: Alexander Mm
authors.initials: AM
authors.lastname: Eggermont
authors.forename: Albertus N
authors.initials: AN
authors.lastname: van Geel
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D006801:Humans; D008545:Melanoma / Q000188:drug therapy* / Q000556:secondary*; D008558:Melphalan / Q000008:administration & dosage; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage*
chemical_list: D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan