Isolated Limb Perfusion with Melphalan and Tumour Necrosis Factor α for In-Transit Melanoma and Soft Tissue Sarcoma.
BACKGROUND
Isolated limb perfusion (ILP) is indicated in locally advanced melanoma and soft tissue sarcoma of the extremities. This series reports the outcome of patients undergoing ILP with melphalan and tumour necrosis factor α (TNFα) at a single centre.


METHODS
All patients undergoing ILP from January 2005 to January 2015 were identified from a prospectively maintained database. Those undergoing ILP for in-transit melanoma (ITM) were grouped according to disease burden: low volume and bulky (>2 cm diameter).


RESULTS
A total of 143 perfusions were attempted: 9 and 134 in the upper and lower limbs, respectively. A response was assessable in 129 patients with overall response rates for ITM and sarcoma of 81.8 and 61.1 %, respectively. No difference was found in response rates between low-volume and bulky ITM. Limb salvage rates in these cohorts were 97 and 62 %. Regional toxicity following ILP was minimal with 7 grade III (5.4 %), and 1 grade V (0.8 %) reactions. Median progression-free survival was 11 months in the ITM cohort and 12 months in the sarcoma cohort. In the ITM cohort, complete responses were significantly more durable than partial responses (p = 0.0004). Median disease-specific survival was 21 months in the ITM cohort and was not reached in the sarcoma cohort.


CONCLUSIONS
TNFα-based ILP is safe and provides excellent palliation of ITM due to rapid progression of systemic disease. It is less effective in sarcoma due to lower initial response rates and a lower incidence of disease dissemination.
The Sarcoma and Melanoma Units, The Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK. henrygsmith@doctors.org.uk.
H G
HG
Smith
The Sarcoma and Melanoma Units, The Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK.
J
J
Cartwright
The Sarcoma and Melanoma Units, The Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK.
M J
MJ
Wilkinson
The Sarcoma and Melanoma Units, The Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK.
D C
DC
Strauss
The Sarcoma and Melanoma Units, The Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK.
J M
JM
Thomas
The Sarcoma and Melanoma Units, The Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK.
A J
AJ
Hayes
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005121:Extremities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012509:Sarcoma / Q000188:drug therapy* / Q000473:pathology; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage*
D018906:Antineoplastic Agents, Alkylating; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan