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The use of regional chemotherapy in the management of malignant melanoma

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Abstract

From 1957 through 1977, a total of 714 patients with malignant melanoma were treated by chemotherapy administered by isolated regional perfusion of the limbs, and 56 patients were treated by intra-arterial infusion.

Excisional surgery and adjunctive perfusion in 286 patients with stage I disease resulted in cumulative survival rates of 87% at 5 years and 75% at 10 and 15 years. With recurrent or metastatic regional disease treated by perfusion alone or in combination with surgical excision, the survival rates were 36%, 34%, and 31% at 5, 10, and 15 years, respectively. Even in the least favorable group, those with nodal and soft tissue involvement, the survival rates were 27% at 5 years and 22.5% at 10 and 15 years. Analysis of 121 patients with stage I melanoma according to level of dermal invasion showed recurrence in 2 of 42 (4%) patients with level III lesions, 11 of 75 (15%) with level IV tumors, and 2 of 4 (50%) with level V lesions. Recurrence rates by pathologic type were 2 of 49 (4%) patients with superficial spreading melanoma, 6 of 30 (20%) with nodular melanoma, and 5 of 14 (36%) with acral lentiginous melanoma, the latter including subungual, plantar, or palmar lesions.

Chemotherapy by intra-arterial infusion is a technique useful in treating regional disease not amenable to isolation-perfusion. Of 36 patients having measurable lesions, there were 4 complete responses. Objective responses occurred in 50–80% of patients treated, depending on the agent used.

As an adjunct to surgical treatment, chemotherapy by isolation-perfusion offers improved survival rates without prolonged treatment or the risks associated with systemic chemotherapy. As primary therapy for advanced regional disease, chemotherapy by perfusion produces survival rates superior to those obtained by surgery alone or systemic chemotherapy.

Résumé

Entre 1957 et 1977, nous avons traité 714 malades atteints de mélanome malin par chimiothérapie en perfusion régionale du membre isolé, et 56 malades par perfusion intra-artérielle.

Pour 286 cas au stade I, la chirurgie d'exérèse associée à la perfusion régionale a donné des survies cumulatives de 87% à 5 ans et de 75% à 10 et 15 ans. Pour les récidives locales ou métastases régionales traitées par perfusion seule ou associée à la chirurgie, les survies ont été de 36% à 5 ans, 34% à 10 ans et 31% à 15 ans. Même pour le groupe le moins favorable, de cas avec envahissement des ganglions et des tissus mous, les survies ont été de 27% à 5 ans et de 22.5% à 10 et 15 ans. Pour 121 mélanomes au stade I, classés selon le degré d'invasion dermique, les récidives ont été de 2/42 (4%) pour les lésions de degré III, de 11/75 (15%) pour les tumeurs au degré IV et 2/4 (50%) pour les degrés V. Selon le type histologique, les fréquences de récidive ont été de 2/49 (4%) pour les mélanomes à extension superficielle, de 6/30 (20%) pour les mélanomes nodulaires et de 5/14 (36%) pour les mélanomes des extrémités à aspect de lentigine, y compris, pour ce dernier groupe, les lésions sousunguéales, plantaires ou palmaires.

La chimiothérapie par perfusion intra-artérielle est utile lorsque la maladie est encore au stade régional mais ne peut être traitée par perfusion du membre isolé. Nous avons eu 4 guérisons chez 36 malades atteints de lésions mesurables et, selon les drogues utilisées, 50 á 80% de réponses objectives.

La chimiothérapie par perfusion du membre isolé, complétant la chirurgie, améliore la survie sans prolonger le traitement et sans les risques de la chimiothérapie systémique. Utilisée comme premiére thérapeutique dans les lésions régionales avancées, elle donne des survies meilleures que ceux de la chirurgie seule ou de la chimiothérapie par voie générale.

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Authors and Affiliations

  1. Department of Surgery, Tulane University School of Medicine, 70112, New Orleans, Louisiana, USA

    Edward T. Krementz M.D., R. Davilene Carter M.D., Carl M. Sutherland M.D. & Marilyn Campbell B.S.,R.N.

  2. Charity Hospital of Louisiana, New Orleans, Louisiana, USA

    Edward T. Krementz M.D., R. Davilene Carter M.D., Carl M. Sutherland M.D. & Marilyn Campbell B.S.,R.N.

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  1. Edward T. Krementz M.D.
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  2. R. Davilene Carter M.D.
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  3. Carl M. Sutherland M.D.
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  4. Marilyn Campbell B.S.,R.N.
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Krementz, E.T., Carter, R.D., Sutherland, C.M. et al. The use of regional chemotherapy in the management of malignant melanoma. World J. Surg. 3, 289–302 (1979). https://doi.org/10.1007/BF01556579

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