Abstract
Background: Despite high rates of complete responses (CRs) to isolated limb perfusion (ILP) for patients with in-transit melanoma (60% to 90%), extremity recurrences are common. We evaluated our experience with managing these recurrences to determine how best to treat these patients.
Methods: Between April 1992 and April 1998, 72 patients experienced CRs after hyperthermic ILP using Melphalan, with (n = 46) or without (n = 26) tumor necrosis factor. Of these, 25 patients (35%) experienced initial recurrences in the extremities, and they form the basis of this study.
Results: Three patients who underwent repeat ILP for treatment of their recurrences experienced a second CR and recurrence in the extremity (at 9, 15, and 16 months), allowing analysis of 28 cases. For 5 of 20 recurrences managed with excision, 2 of 6 managed with repeat ILP, and 0 of 2 managed with systemic treatment, the patient was free of disease at the last follow-up examination (median follow-up period, 11 months).
Conclusions: Isolated extremity recurrences after CRs to ILP occurred in 35% of patients. Initially, these could be managed successfully by excision or repeat ILP for the majority of patients (92%). We recommend excision of small-volume recurrent disease, reserving repeat ILP for patients with increasing numbers of lesions or increasing rapidity of in-field recurrences.
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REFERENCES
Creech O, Krementz ET, Ryan RF, Winblad JN, et al. Chemotherapy of cancer: regional perfusion utilizing an extracorporeal circuit. Ann Surg 1958;148:616–32
Stehlin JS, et al. Hyperthermic perfusion with chemotherapy for cancers of the extremities. Surg Gynecol Obstet 1969;129:305–8
Alexander HR, Fraker DL, Bartlett DL, et al. Isolated limb perfusion for malignant melanoma. Semin Surg Oncol 1996;12:416–28
Bartlett DL, Ma G, Alexander HR, Libutti SK, Fraker DL, et al. Isolated limb reperfusion with tumor necrosis factor and Melphalan in patients with extremity melanoma after failure of isolated limb perfusion with chemotherapeutics. Cancer 1997;80:2084–90
Lie’nard D, Eggermont AM, Kroon BBR, Koops HW, Lejeune FJ, et al. Isolated limb perfusion in primary and recurrent melanoma: indications and results. Semin Surg Oncol 1998;14:202–9
Lingam MK, Byrne DS, Airchison T, MacKie RM, McKay AJ, et al. A single centre’s 10 year experience with isolated limb perfusion in the treatment of recurrent malignant melanoma of the limb. Eur J Cancer 1996;32A:1668–73.
Thompson JF, Hunt JA, Shannon KF, Kam PC, et al. Frequency and duration of remission after isolated limb perfusion for melanoma. Arch Surg 1997;132:903–7
Hansson JA, Simert G, Vang J, et al. The effect of regional perfusion treatment on recurrent melanoma of the extremities. Acta Chir Scand 1977;143:33–9
Barker WC, Andrich MP, Alexander HR, et al. Continuous intraoperative external monitoring of perfusate leak using I-131 human serum albumin during isolated perfusion of the liver and limbs. Eur J Nucl Med 1995;22:1242–8
Storm FK, Morton DL, et al. Value of therapeutic hyperthermic limb perfusion in advanced recurrent melanoma of the lower extremity. Am J Surg 1985;150:32–5
di Filippo F, Calabro A, Giannarelli D, et al. Prognostic variables in recurrent limb melanoma treated with hyperthermic antiblastic perfusion. Cancer 1989;63:2551–61
Kroon BBR, Klaase JM, van de Merwe SA, van Dongen JA, van der Zee J, et al. Results of a double perfusion schedule using high-dose hyperthermia and Melphalan sequentially for recurrent melanoma of the limbs: a pilot study. Reg Cancer Treat 1992;4:305–8
Lejeune FJ, Lie’nard D, Leyvraz S, Mirimanoff RO, et al. Regional therapy of melanoma. Eur J Cancer 1993;294:606–12
Klaase JM, Kroon BBR, van Geel AN, Eggermont AMM, Franklin HR, Hart AAM, et al. Prognostic factors for tumor response and limb recurrence-free interval in patients with advanced melanoma of the limbs treated with regional isolated perfusion using elphalan. Surgery 1994;115:39–45
McClay EF, Mastrangelo MJ, Berd D, et al. Effective combination chemo/hormonal therapy for malignant melanoma: experience with three consecutive trials. Int J Cancer 1992;50:553–6
Rusthoven JJ, Quirt KC, Iscoe NA, et al. Randomized, double-blind, placebo-controlled trial comparing the response rates of carmustine, dacarbazine, and cisplatin with and without tamoxifen in patients with metastatic melanoma. J Clin Oncol 1996;14:2083–90
Rosenberg SA, Yang JC, Schwartzentruber DJ, et al. Immunologic and therapeutic evaluation of a synthetic peptide vaccine for the treatment of patients with metastatic melanoma. Nat Med 1998;4: 321–7.
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Feldman, A.L., Alexander, H.R., Bartlett, D.L. et al. Management of Extremity Recurrences After Complete Responses to Isolated Limb Perfusion in Patients With Melanoma. Ann Surg Oncol 6, 562–567 (1999). https://doi.org/10.1007/s10434-999-0562-x
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DOI: https://doi.org/10.1007/s10434-999-0562-x