title: Current trends in regional therapy for melanoma: lessons learned from 225 regional chemotherapy treatments between 1995 and 2010 at a single institution.
abstract: BACKGROUND
  Hyperthermic isolated limb perfusion (HILP) and isolated limb infusion (ILI) are used to manage advanced extremity melanoma, but no consensus exists as to which treatment is preferable and how to monitor patients post-treatment.
  
  
  METHODS
  Using a prospectively maintained database, we reviewed our experience with melphalan-based HILP (which included 62 first-time and 10 second-time) and ILI (which included 126 first-time and 18 second-time) procedures performed in 188 patients. PET/CT was obtained 3 months postregional treatment for 1 year and then every 6 months thereafter.
  
  
  RESULTS
  Overall response rate (complete response [CR] + partial response) of HILP was 81% (80% CI, 73-87%), and overall response rate from ILI was 43% (80% CI, 37-49%) for first-time procedures only. HILP had a CR rate of 55% with a median duration of 32 months, and ILI had a CR rate of 30% with median duration of 24 months. Patients who experienced a regional recurrence after initial regional treatment were more likely to achieve a CR after repeat HILP (50%, n = 10) compared with repeat ILI (28%, n = 18). Although the spectrum of toxicity was similar for ILI and HILP, the likelihood of rare catastrophic complication of limb loss was greater with HILP (2 of 62) than ILI (0 of 122). PET/CT was effective for surveillance after regional therapy to identify regional nodal and pulmonary disease that was not clinically evident, but often amenable to surgical resection (25 of 49; 51% of cases). In contrast, PET/CT was not effective at predicting complete response to treatment with an accuracy of only 50%.
  
  
  CONCLUSIONS
  In the largest single-institution regional therapy series reported to date, we found that although ILI is effective and well-tolerated, HILP is a more definitive way to control advanced disease.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Raymond
authors.forename: Georgia M
authors.initials: GM
authors.lastname: Beasley
authors.forename: Gloria
authors.initials: G
authors.lastname: Broadwater
authors.forename: Christina K
authors.initials: CK
authors.lastname: Augustine
authors.forename: James C
authors.initials: JC
authors.lastname: Padussis
authors.forename: Ryan
authors.initials: R
authors.lastname: Turley
authors.forename: Bercedis
authors.initials: B
authors.lastname: Peterson
authors.forename: Hilliard
authors.initials: H
authors.lastname: Seigler
authors.forename: Scott K
authors.initials: SK
authors.lastname: Pruitt
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D035002:Lower Extremity; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary*; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012878:Skin Neoplasms / Q000473:pathology*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan