title: Results of isolated lower limb perfusion for loco-regional advanced/recurrent melanoma using borderline true hyperthermia plus additional bolus of melphalan. A critical analysis of homogeneous cases.
abstract: OBJECTIVE
  This study was conducted to assess the safety and efficacy of our modified ILP treatment with borderline true hyperthermia and high melphalan concentration in stage III lower limb melanoma.
  
  
  METHODS
  Between March 1990 and December 2006, 91 consecutive patients were given ILP treatment. Forty three patients were treated with double L-PAM bolus combined with D-actinomicin; 48 patients were treated with additional L-PAM bolus alone.
  
  
  RESULTS
  The mean follow-up period is 68.5 months. The acute regional toxicity occurred with grade II (54%), III (38%), IV (2.1%). The systemic toxic effects were present with transitory hematological disorders. Complete response (CR) rate was observed in 89.2% of stage IIIA-IIIAB unexcised IT-mets. The overall limb recurrent disease in stage III was 39%. In patients with CR recurrent rate occurred in 44% with a mean limb recurrence-free interval (LRFI) of 23.8 months. Distant metastases was attained with a mean time of 29.2 months. After CR, the interval was 32.1 months. The 5-year survival rate was 45%; in patients with CR, was 48%.
  
  
  CONCLUSIONS
  Our procedure is an important therapeutic option. The results suggest a marked local control of the recurrent disease. The LRFI is longer than for those treated with other treatment schedules.
authors: Department of Medical and Surgical Critical Care, University of Florence, Regional Reference Centre of Tuscany for Locoregional Perfusion Therapies in Oncology, Florence, Italy. marcello.pace@unifi.it
authors: Marcello
authors: M
authors: Pace
authors: Riccardo
authors: R
authors: Gattai
authors: Erminia M
authors: EM
authors: Mascitelli
authors: Luigi
authors: L
authors: Millanta
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage* / Q000009:adverse effects; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D007866:Leg; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology; D008558:Melphalan / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016019:Survival Analysis
chemical_list: D018906:Antineoplastic Agents, Alkylating; D008558:Melphalan