title: In-transit Merkel cell carcinoma treated with isolated limb perfusion or isolated limb infusion: a case series of 12 patients.
abstract: BACKGROUND
  In-transit metastases of Merkel cell carcinoma (MCC) are an unusual and therapeutically challenging manifestation of the disease. Given the similarity to melanoma, in-transit MCC may be amenable to isolated regional therapy.
  
  
  OBJECTIVE
  To present a case series of 12 patients who underwent isolated limb perfusion (ILP) or isolated limb infusion (ILI) for in-transit MCC.
  
  
  METHODS
  A literature search was conducted using Medline and Pubmed databases for MCC, ILP, and ILI as key words. Ten cases were identified and reviewed; two cases from our hospital were also included in the series.
  
  
  RESULTS
  Nine patients underwent ILP, and three were treated with ILI. Eleven patients had a complete clinical response, and one had a partial response. All patients avoided limb amputation. Mean follow-up was 25.3 months. Mean duration of response was 21.8 months. Four patients relapsed regionally. Two patients developed distant metastases and died of their disease.
  
  
  CONCLUSIONS
  This is the largest case series of in-transit MCC treated with ILP or ILI. Both techniques appear to be a low-morbidity alternative to amputation for the treatment of isolated extremity in-transit MCC. ILI is less invasive than ILP and may be a more practical first-line treatment option. The authors have indicated no significant interest with commercial supporters.
authors.affiliation: Department of Dermatology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA. nathalie.zeitouni@roswellpark.org
authors.forename: Nathalie C
authors.initials: NC
authors.lastname: Zeitouni
authors.forename: Cerrene N
authors.initials: CN
authors.lastname: Giordano
authors.forename: John M
authors.initials: JM
authors.lastname: Kane
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D015266:Carcinoma, Merkel Cell / Q000188:drug therapy* / Q000473:pathology; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods*; D023821:Limb Salvage / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan