Skip to main content
SpringerLink
Log in

Tourniquet infusion chemotherapy for extremity in-transit lesions in malignant melanoma

  • Original Articles
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: Perfusion remains the standard of regional chemotherapy for extremity in-transit lesions from melanoma. However, there is an interest in other forms of intraarterial chemotherapy due to the simplicity and feasibility of repeat administration of the latter.

Methods: Review of 51 patients with extremity in-transit lesions from melanoma treated with the tourniquet infusion (TI) method on the basis of a prospective protocol. Drugs used were either Adriamycin (group A) or Dacarbazine (DTIC) + cisDDP (group B). The median number of courses was two. Lesions were resected at the same time as TI (n=27) or after a month or more of observation in the absence of complete regression.

Results: There was no significant difference in response rates between groups A and B. The overall objective response rate in 24 evaluable patients was 75%, being complete in seven (29%), partial (>50%) in 11 (46%), minor (<50%) in three (12.5%), and progression of disease in three (12.5%). At a mean follow-up time of 40 months, no recurrence was observed in the treated extremity in 18 patients (35%), but further recurrences were noted in 31 patients (61%). The 5-year survival rate was 30%.

Conclusion: TI provides an objective response rate of 75% for in-transit Iesions, but after TI and resection of in-transit lesions as needed, the recurrence rate in the treated extremity is high (61%). Further work is needed with higher drug doses, local hyperthermia, or the administration of suitable doses of new regimens that are more successful with perfusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Karakousis CP, Kanter PM, Lopez R, Moore R, Holyoke ED. Modes of regional chemotherapy.J Surg Res 1979;26:134–41.

    Article  CAS  PubMed  Google Scholar 

  2. Karakousis CP, Row U, Holterman DA, Kanter PM, Holyoke ED. Tourniquet infusion chemotherapy in extremities with malignant lesions.Surg Gynecol Obstet 1979;149:481–90.

    CAS  PubMed  Google Scholar 

  3. Karakousis LP, Kanter PM, Park HC, Sharma SD, Moore R, Ewing JH. Tourniquet infusion versus hyperthermic perfusion.Cancer 1982;49:850–8.

    CAS  PubMed  Google Scholar 

  4. Karakousis CP, Kontzoglou K, Driscoll DL. Tourniquet infusion (TI) chemotherapy for extremity in-transit lesions in malignant melanoma. Society of Surgical Oncology, 49th Annual Cancer Symposium, March 21–24, 1996, Atlanta, GA, pp 52.

  5. Ketcham AS, Moffet FL, Balch CM. Classification and staging. In: Balch CM, Houghton AN, Milton GW, Sober AJ, Soong SJ, eds.Cutaneous Melanoma. 2nd ed. Philadelphia: JB Lippincott, 1992:213–20.

    Google Scholar 

  6. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations.J Am Stat Assoc 1958;53:457–86.

    Google Scholar 

  7. Krementz ET, Carter RD, Sutherland CM, Campbell M. The use of regional chemotherapy in the management of malignant melanoma.World J Surg 1979;3:289–304.

    Article  CAS  PubMed  Google Scholar 

  8. Hafstrom L, Jonsson PE: Hyperthermic perfusion of recurrent malignant melanoma on the extremities.Acta Chir Scand 1980;146:313–8.

    CAS  PubMed  Google Scholar 

  9. Lienard D, Lejeune FJ, Delmotte JJ, et al. High dose of rTNF-a in combination with IFN-gamma and melphalan in isolated perfusion of the limbs for melanoma and sarcoma.J Clin Oncol 1991;122:52–60.

    Google Scholar 

  10. Lienard D, Eggermont AM, Schraffordt Koops H, et al. Isolated perfusion of the limb with high-dose tumour necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma) and melphalan for melanoma stage III. Results of a multi-centre pilot study.Melanoma Res 1994;4(suppl 1):21–6.

    PubMed  Google Scholar 

  11. Klaase JM, Kroon BB, Eggermont AM, et al. A retrospective comparative study evaluating the results of mild hyperthermic versus controlled normothermic perfusion.Eur J Cancer 1995;31A:58–63.

    CAS  PubMed  Google Scholar 

  12. Krementz ET, Carter RD, Sutherland CM, Muchmore JH, Ryan RF, Creech O Jr. Regional chemotherapy for melanoma. A 35-year experience.Ann Surg 1994;220:520–34.

    CAS  PubMed  Google Scholar 

  13. Krementz ET, Sutherland CM, Muchmore JH. Isolated hyperthermic chemotherapy perfusion for limb melanoma.Surg Clin North Am 1996;76:1313–31.

    Article  CAS  PubMed  Google Scholar 

  14. Ghussen F, Nagel K, Groth W, et al. A prospective randomized study of regional extremity perfusion in patients with malignant melanoma.Ann Surg 1984;200:764–8.

    CAS  PubMed  Google Scholar 

  15. Ghussen F, Kruger I, Smalley RV, Groth W. Hyperthermic perfusion with chemotherapy and melanoma of the extremities.World J Surg 1989;13:598–602.

    Article  CAS  PubMed  Google Scholar 

  16. Hafstrom L, Rudenstein CM, Blomquist E, et al. Regional hyperthermic perfusion with melphalan after surgery for recurrent malignant melanoma of the extremities. Swedish Melanoma Study Group.J Clin Oncol 1991;9:2091–4.

    CAS  PubMed  Google Scholar 

  17. Schraffordt-Koops H, Kroon BB, Oldhoff J, Hoekstra HJ. Controversies concerning adjuvant regional isolated perfusion from stage I melanoma of the extremities.World J Surg 1992;16:241–5.

    CAS  PubMed  Google Scholar 

  18. Skene AL, Bulman AS, Williams TR, Thomas JM, Westburg G. Hyperthermic isolated perfusion with melphalan in the treatment of advanced malignant melanoma of the lower limb.Br J Surg 1990;77:765–7.

    CAS  PubMed  Google Scholar 

  19. Klaase JM, Kroon BB, van Geel AN, Eggermont AM, Franklin HR, Hart AA. Prognostic factors for tumor response and limb recurrence free interval in patients with advanced melanoma of the limbs treated with regional isolated perfusion with melphalan.Surgery 1994;115:39–45.

    CAS  PubMed  Google Scholar 

  20. Klaase JM, Kroon BB, van Geel AN, et al. Limb recurrence-free interval and survival in patients with recurrent melanoma of the extremities treated with nomothermic isolation perfusion.J Am Coll Surg 1994;178:564–72.

    CAS  PubMed  Google Scholar 

  21. Klaase JM, Kroon BB, van Geel AN, Eggermont AM, Franklin HR, van Dougen JA. Is there an indication for a double perfusion schedule with melphalan for patients with recurrent melanoma of the limbs?Melanoma Res 1994;4(suppl 1):13–6.

    PubMed  Google Scholar 

  22. Kapteijn BA, Klaase JM, van Geel AN, Eggermont AM, Kroon BB. Results of regional isolated perfusion for locally inoperable melanoma of the limbs.Melanoma Res 1994;4:135–8.

    CAS  PubMed  Google Scholar 

  23. Bryant PJ, Balderson GA, Mead P, Egerton WS. Hyperthermic isolated limb perfusion for malignant melanoma: response and survival.World J Surg 1995;19:363–8.

    Article  CAS  PubMed  Google Scholar 

  24. Klop WM, Vrouenraets BC, van Geel BN, et al. Repeat isolation limb perfusion with melphalan for recurrent melanoma of the limbs.J Am Coll Surg 1996;82:467–72.

    Google Scholar 

  25. Lejeune F, Lienard D, Eggermont A, et al. Administration of high-dose tumor necrosis factor alpha by isolation perfusion of the limbs. Rationale and results.J Infusional Chemotherapy 1995;5:73–81.

    CAS  Google Scholar 

  26. Fraker DL, Alexander HR, Andrich M, Rosenberg SA. Treatment of patients with melanoma of the extremity using hyperthermic isolated limb perfusion with melphalan, tumor necrosis factor, and interferon gamma: results of a tumor necrosis factor dose-escalation study.J Clin Oncol 1996;14:479–89.

    CAS  PubMed  Google Scholar 

  27. Vaglini M, Santinami M, Manzi R, et al. Treatment of in-transit metastases from cutaneous melanoma by isolation perfusion with tumour necrosis factor-alpha (TNF-alpha), melphalan and interferon-gamma (IFN-gamma). Dose-binding experience at the National Cancer Institute of Milan.Melanoma Res 1994;4(suppl 1):35–8.

    PubMed  Google Scholar 

  28. Bowers GJ, Copeland EM. Surgical limb perfusion for extremity melanoma.Surg Oncol 1994;3:91–102.

    Article  CAS  PubMed  Google Scholar 

  29. Bland KI, Kimura AK, Brenner DA, et al. A phase II study of the efficacy of diamminedichloroplatinum (cisplatin) for the control of locally recurrent and in-transit malignant melanoma of the extremities using tourniquet outflow-occlusion techniques.Ann Surg 1989;209:73–80.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Millard Fillmore Hospital, From the State University of New York, USA

    Constantine P. Karakousis MD, PhD

  2. Roswell Park Cancer Institute, Buffalo, New York, USA

    Konstantinos Kontzoglou MD

  3. Surgical Oncology, Millard Fillmore Hospital, 3 Gates Circle, 14209, Buffalo, NY, USA

    Deborah L. Driscoll BA

Authors
  1. Constantine P. Karakousis MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Konstantinos Kontzoglou MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deborah L. Driscoll BA
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Karakousis, C.P., Kontzoglou, K. & Driscoll, D.L. Tourniquet infusion chemotherapy for extremity in-transit lesions in malignant melanoma. Annals of Surgical Oncology 4, 506–510 (1997). https://doi.org/10.1007/BF02303677

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02303677

Key Words

Search

Navigation