Isolated Limb Perfusion for Malignant Melanoma: Systematic Review on Effectiveness and Safety

Moreno‐Ramírez, D.; Cruz‐Merino, Luis de la; Ferrándiz, Lara; Villegas, R.; Nieto-García, Adoración

doi:10.1634/theoncologist.2009-0325

Cited by 126 publications

(114 citation statements)

References 47 publications

(70 reference statements)

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“…A large systematic review (n=2018 ILPs; 22 trials) found that for patients with unresectable stage IIIB-IIIC metastatic melanoma of the limbs, studies published between 1990 and 2008 reported a median overall response rate of 90% (range, 64%-100%) and a median complete response rate of 58% (range, 25%-89%). 160 Median complete response rate varied somewhat depending on the agents used, ranging from 47% with single-agent melphalan, 45% to 65% for melphalan/actinomycin D combination, and up to 70% with melphalan/TNF-alfa combination. 160 These response rates are mostly derived from retrospective series, and the differences reported depend on definitions of response often spanning decades and on patient selection factors.…”

Section: Regional Therapy: Isolated Limb Perfusion and Infusionmentioning

confidence: 99%

“…160 Median complete response rate varied somewhat depending on the agents used, ranging from 47% with single-agent melphalan, 45% to 65% for melphalan/actinomycin D combination, and up to 70% with melphalan/TNF-alfa combination. 160 These response rates are mostly derived from retrospective series, and the differences reported depend on definitions of response often spanning decades and on patient selection factors. The reported differences in response rates may not be clinically significant.…”

Section: Regional Therapy: Isolated Limb Perfusion and Infusionmentioning

confidence: 99%

“…157,158 Although other agents have been used for ILP, and many have yet to be tested, melphalan (L-phenylalanine mustard) is the cytotoxic agent most commonly used, often in combination with either actinomycin D or TNF-alfa. [158][159][160][161] Response rates after ILP have improved as the method has been refined. A large systematic review (n=2018 ILPs; 22 trials) found that for patients with unresectable stage IIIB-IIIC metastatic melanoma of the limbs, studies published between 1990 and 2008 reported a median overall response rate of 90% (range, 64%-100%) and a median complete response rate of 58% (range, 25%-89%).…”

Section: Regional Therapy: Isolated Limb Perfusion and Infusionmentioning

confidence: 99%

See 2 more Smart Citations

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Coit¹,

Thompson²,

Algazi³

et al. 2016

J Natl Compr Canc Netw

218

167

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OverviewIn 2016, an estimated 76,380 patients will be diagnosed with and approximately 10,130 patients will die of melanoma in the United States.1 However, these figures for new cases may represent a substantial underestimate, as many superficial and in situ melanomas treated in the outpatient setting are not reported. The incidence of melanoma continues to increase dramatically, at an overall rate of 33% for men and 23% women from 2002 to 2006.2 Melanoma is increasing in men more rapidly than any other malignancy, and in women more rapidly than any other malignancy except lung cancer. AbstractThis selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Melanoma focuses on adjuvant therapy and treatment of in-transit disease, because substantial changes were made to the recommendations for the 2016 update. Depending on the stage of the disease, options for adjuvant therapy now include biochemotherapy and highdose ipilimumab. Treatment options for in-transit disease now include intralesional injection with talimogene laherparepvec (T-VEC), a new immunotherapy. These additions prompted reassessment of the data supporting older recommended treatment options for adjuvant therapy and in-transit disease, resulting in extensive revisions to the supporting discussion sections. J Natl Compr Canc Netw 2016;14(4):450-473 NCCN Categories of Evidence and ConsensusCategory 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate.All recommendations are category 2A unless otherwise noted.Clinical trials: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ® ) are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines ® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network ® (NCCN ® ) makes no representation or warranties of any kind regarding their content, use, or application and disclaims any responsibility for their applications or use in any way. The full NCCN Guidelines for Melanoma are not printed in this issue of JNCCN but can be accessed online at NCCN.org.© National Comprehensive Cancer Network, Inc. 2016, All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. Disclosures for the NCCN Melanoma ...

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Section: Regional Therapy: Isolated Limb Perfusion and Infusionmentioning

confidence: 99%

Section: Regional Therapy: Isolated Limb Perfusion and Infusionmentioning

confidence: 99%

Section: Regional Therapy: Isolated Limb Perfusion and Infusionmentioning

confidence: 99%

See 1 more Smart Citation

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Coit¹,

Thompson²,

Algazi³

et al. 2016

J Natl Compr Canc Netw

218

167

View full text Add to dashboard Cite

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“…At any rate, it should be considered prior to limb amputation (e.g. because of ulceration of recurrent melanoma) [435,438].…”

Section: Clinical Aspects With Regard To Indicationmentioning

confidence: 99%

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

Pflugfelder

Kochs

Blum

et al. 2013

J Deutsche Derma Gesell

180

148

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“…In a systematic review of 22 studies with 2,018 patients [5], the median complete remission rate (CR) was 58 %, and the response rate (PR + CR) was 90 %; the response rate for melphalan, given as monotherapy, was 46 % and thus lower than when it is used in combination with TNF-a (69 %). Treatment success depends on factors such as tumor stage, the number of in-transit metastases (< 10), and a maximum tumor diameter of < 4 cm [6].…”

Section: Extremity Perfusionmentioning

confidence: 99%

Palliative treatment of skin metastases in dermato‐oncology

Kähler

Egberts

Gutzmer

2013

J Deutsche Derma Gesell

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SummaryPatients with metastatic melanoma, but also other solid tumors (e.g., lung or breast cancer), may develop cutaneous metastases in advanced stages. The goal of treatment is to alleviate symptoms such as pain, fetor, secretions, or bleeding. Current treatment modalities are based on a multimodal treatment approach. Beside surgery, treatment options such as electrochemotherapy, isolated limb perfusion, radiotherapy, and local administration of cytokines or chemotherapy agents are available. In case of concomitant visceral metastases, this local treatment approach may not affect overall survival, but the palliation of these tumor-associated symptoms very often improves the quality of life for the patient. IntroductionAlong with primary skin tumors, which are usually still treatable at the time of diagnosis with curative surgery, palliative treatment of cutaneous metastases from solid tumors (such as carcinomas of the breast, kidney, prostate gland, lungs and other organs) seen in everyday dermatological practice require individually-tailored, multimodal treatment. About 10 % of patients with solid tumors develop cutaneous or subcutaneous metastases over the course of their disease [1]. Typical problemsSkin metastases from solid tumors behave in a similar fashion, irrespective of the tumor entity. The lesions may be distressing for the patient, due to their visibility or symptoms such as weeping, bleeding, pain, and fetor ( Figure 1) [1]. Intense fetor, in particular, can significantly impair the patient's quality of life and lead to social isolation. Given the often very distressful symptoms, even in patients with visceral metastases, the treatment of the skin metastases may take precedent. Palliative therapy options in skin metastases Ablative techniquesVisible skin metastases are often very distressful for the patient. Excision is the firstline therapy for solitary skin metastases [2]. Other alternatives include cryotherapy as well as laser therapy for flatter lesions. Doctors should discuss the advantages and disadvantages with the patient. One may also consider combining resection of a large lesion with topical treatment of multiple smaller metastases. Radiotherapy IndicationsPain related to skin metastases primarily occurs with space-occupying masses; weeping, bleeding, fetor may occur due to tumor disintegration. Palliative radiotherapy is mainly indicated to alleviate the symptoms as quickly as possible rather than to achieve a reduction in tumor size (i.e., debulking) [3]. In palliative radiotherapy, fractionation is based on an individual treatment decision, taking into account the personal needs of the patient. Long-term toxic effects should be avoided. The treatment should be brief, and thus higher individual doses (3.0-4.0-8.0 Gy), or hypofractionation, may be advisable. The length of treatment is significantly minimized, depending on the individual dose (one day, one week, two weeks). A prerequisite is adequate relative biological effectiveness which brings about rapid, lasting, and certain pain...

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Isolated Limb Perfusion for Malignant Melanoma: Systematic Review on Effectiveness and Safety

Cited by 126 publications

References 47 publications

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

Palliative treatment of skin metastases in dermato‐oncology

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