Abstract | BACKGROUND: Approximately 5-8% of melanoma patients will develop in-transit metastases (IT-mets). Tumor necrosis factor-α (TNF) and melphalan-based isolated limb perfusion (TM-ILP) is an attractive treatment modality in melanoma patients with multiple IT-mets. This study reports on a 20 years experience and outlines the evolution and major changes since the introduction of TNF in ILP. METHODS: A total of 167 TM-ILPs were performed in 148 patients, between 1991 and 2009. TM-ILPs were performed at high doses of TNF (3-4 mg) from 1991 to 2004 (n = 99) and at low doses of TNF (1-2 mg) from 2004 to 2009 (n = 68) under mild hyperthermic conditions (38°C-39.5°C.). Melphalan doses were unchanged at 10-13 mg/l (leg and arm, respectively). Characteristics for the 167 ILPs were: 81 stage IIIB, 65 stage IIIC, and 21 stage IV disease. RESULTS: The overall response rate was 89% (n = 148). (Complete response [CR] = 61%; partial response [PR] = 28%). CR rates correlated with stage (P = .001) and with high-dose vs. low-dose TNF (70% vs. 49%; P < .006). High-dose TNF prolonged local control (median 16 months vs. 11 months; P = .076). Survival was not influenced by TNF dose. CR after ILP and number of lesions also correlated with local progression-free interval. Overall survival did correlate with stage of disease (P < .001), size of the lesions (P = .001), and a CR (P < .001). CONCLUSIONS: This 2-decade single-center experience demonstrates that TM-ILP is a safe and effective treatment modality for melanoma patients with multiple IT-mets. Higher dose of TNF was associated with significantly higher CR rates and prolonged local control without an effect on overall survival.
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Authors | Jan P Deroose, Alexander M M Eggermont, Albertus N van Geel, Johannes H W de Wilt, Jacobus W A Burger, Cornelis Verhoef |
Journal | Annals of surgical oncology
(Ann Surg Oncol)
Vol. 19
Issue 2
Pg. 627-35
(Feb 2012)
ISSN: 1534-4681 [Electronic] United States |
PMID | 21879272
(Publication Type: Journal Article)
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Chemical References |
- Antineoplastic Agents, Alkylating
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Alkylating
(therapeutic use)
- Chemotherapy, Cancer, Regional Perfusion
- Female
- Follow-Up Studies
- Humans
- Leg
- Male
- Melanoma
(drug therapy, mortality)
- Middle Aged
- Neoplasm Staging
- Remission Induction
- Survival Rate
- Time Factors
- Treatment Outcome
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