Annals of Surgical Oncology

, Volume 17, Issue 11, pp 3000–3007

Long-Term Results of Melphalan-Based Isolated Limb Perfusion With or Without Low-Dose TNF for In-Transit Melanoma Metastases

  • Carlo Riccardo Rossi
  • Sandro Pasquali
  • Simone Mocellin
  • Antonella Vecchiato
  • Luca Giovanni Campana
  • Pierluigi Pilati
  • Antonio Zanon
  • Donato Nitti
Melanomas

DOI: 10.1245/s10434-010-1104-2

Cite this article as:
Rossi, C.R., Pasquali, S., Mocellin, S. et al. Ann Surg Oncol (2010) 17: 3000. doi:10.1245/s10434-010-1104-2

Abstract

Background

The aims of the study were: (1) to determine toxicity, response rate, local-regional control, and survival in the entire population of the perfused patients; (2) to compare toxicity, response, and survival among patients who underwent melphalan-based perfusion with or without low-dose tumor necrosis factor (TNF); and (3) to identify factors that predict a complete response and survival.

Materials and Methods

A total of 53 patients with extensive in-transit metastases (47%) underwent perfusion with melphalan, and 59 (53%) also received low-dose TNF.

Results

No difference was observed between the 2 drug regimens for what concerns local toxicity (P = 1.0). The tumor complete response rate was higher in patients treated with TNF (60.3% versus 41.5%, P = .036), in particular in the case of locally advanced tumors (66.7% versus 30%, P = .049). The presence of lymph node metastases had a negative influence on the tumor response rate (P = .003). Median time to local progression and survival were 19.6 and 34.5 months, respectively. Long-term complete response was achieved in 68% of the patients with initial CR (39 of 57 patients). The tumor response after perfusion was the only prognostic factor for local control and survival (P < .0001 and P = .002, respectively).

Conclusions

In the case of locally advanced disease, the addition of low-dose TNF to melphalan-based isolated limb perfusion appears safe and particularly useful. The presence of lymph node metastases is associated with decreased response rates. A sustained complete response was obtained in about one-third of the patients.

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Carlo Riccardo Rossi
    • 1
    • 2
  • Sandro Pasquali
    • 1
  • Simone Mocellin
    • 1
  • Antonella Vecchiato
    • 2
  • Luca Giovanni Campana
    • 1
    • 2
  • Pierluigi Pilati
    • 1
  • Antonio Zanon
    • 1
  • Donato Nitti
    • 1
  1. 1.Department of Oncological and Surgical SciencesUniversity of PadovaPadovaItaly
  2. 2.Melanoma and Sarcoma UnitIstituto Oncologico Veneto, IRCCSPadovaItaly