Isolated limb infusion chemotherapy with or without hemofiltration for recurrent limb melanoma.
OBJECTIVE
To better define the efficacy and the safety of intra-arterial infusion performed with or without hemofiltration for recurrent limb melanoma.


METHODS
Patients with the following characteristics were included in the study: recurrent limb melanoma not indicated for surgical resection, measurable disease in the extremity, > 18 years, performances status (Eastern Cooperative Oncology Group ) was 0-1 and life expectancy of at least 6 mo. Twenty nine consecutive patients were enrolled in the study. Patients underwent fluoroscopic placement of angiographic arterial and venous catheters to infuse the drug in the artery [isolated limb infusion (ILI)], and to stop the out flow (venous). Melphalan was rapidly infused into the isolated limb via the arterial catheter after the inflation of venous balloon catheter. Then the circulation of the limb was completely blocked with a pneumatic cuff at the root of the limb. Haemofiltration (HF) was available only in the main center, and was performed with an extracorporeal perfusion system, in order to reduce high systemic toxic peaks of drug.


RESULTS
Thirty seven ILI were done in 29 cases (31 ILI-HF and 6 ILI) between 2001 and 2014 at Ancona and Pesaro Hospitals, Italy. Clinical outcomes were monitored 30 d after treatment. Eleven patients (38%) received infusion of melphalan alone, 7 (24%) melphalan associated to mitomicin C and 7 (24%) melphalan associated to cisplatin, the remaining 4 were treated with cisplatin, melphalan and epirubicin or cisplatin and mitomicin C. The overall response rate was 66%, in particular, 3 patients (10%) were complete responders and 16 (56%) were partial responders; whereas 7 patients (24%) had stable disease, and 3 (10%) showed progressive disease. Limb toxicity was assessed adopting Wieberdink scale, with evidence of 90% of low grade (I and II) toxicity.


CONCLUSIONS
ILI-HF and ILI are effective and safe treatments for recurrent non-resectable limb melanoma. They present evidence of favorable clinical benefit and is effective in delaying progression.
Sara Cecchini, Stefano Ricci, Ludovico Delle Vergini, Manuela Sallei, Department of Vascular and Interventional Radiology, INRCA Hospital- IRCCS, 60127 Ancona, Italy.
Sara
S
Cecchini
Sara Cecchini, Stefano Ricci, Ludovico Delle Vergini, Manuela Sallei, Department of Vascular and Interventional Radiology, INRCA Hospital- IRCCS, 60127 Ancona, Italy.
Donatella
D
Sarti
Sara Cecchini, Stefano Ricci, Ludovico Delle Vergini, Manuela Sallei, Department of Vascular and Interventional Radiology, INRCA Hospital- IRCCS, 60127 Ancona, Italy.
Stefano
S
Ricci
Sara Cecchini, Stefano Ricci, Ludovico Delle Vergini, Manuela Sallei, Department of Vascular and Interventional Radiology, INRCA Hospital- IRCCS, 60127 Ancona, Italy.
Ludovico Delle
LD
Vergini
Sara Cecchini, Stefano Ricci, Ludovico Delle Vergini, Manuela Sallei, Department of Vascular and Interventional Radiology, INRCA Hospital- IRCCS, 60127 Ancona, Italy.
Manuela
M
Sallei
Sara Cecchini, Stefano Ricci, Ludovico Delle Vergini, Manuela Sallei, Department of Vascular and Interventional Radiology, INRCA Hospital- IRCCS, 60127 Ancona, Italy.
Stefano
S
Serresi
Sara Cecchini, Stefano Ricci, Ludovico Delle Vergini, Manuela Sallei, Department of Vascular and Interventional Radiology, INRCA Hospital- IRCCS, 60127 Ancona, Italy.
Giuseppe
G
Ricotti
Sara Cecchini, Stefano Ricci, Ludovico Delle Vergini, Manuela Sallei, Department of Vascular and Interventional Radiology, INRCA Hospital- IRCCS, 60127 Ancona, Italy.
Luca
L
Mulazzani
Sara Cecchini, Stefano Ricci, Ludovico Delle Vergini, Manuela Sallei, Department of Vascular and Interventional Radiology, INRCA Hospital- IRCCS, 60127 Ancona, Italy.
Fabrizia
F
Lattanzio
Sara Cecchini, Stefano Ricci, Ludovico Delle Vergini, Manuela Sallei, Department of Vascular and Interventional Radiology, INRCA Hospital- IRCCS, 60127 Ancona, Italy.
Giammaria
G
Fiorentini
Hemofiltration; Intra-arterial infusion; Melphalan; Metastatic melanoma