Regional Chemotherapy for Melanoma A 35-Year Experience

Abstract

ObjectiveThe authors present their 35-year experience with intra-arterial chemotherapeutic regionai perfusion of 1 139 patients with melanomas, using an extracorporeal oxygenated circuft and heart-lung apparatus. Summary Background DataIntra-arterial chemotherapy produces improved responses in many tumors. By isolating and sustaining the area with extracorporeal oxygenated circulation, high doses can be delivered to the tumor area, limited only by local toxicity. Drug levels up to 10 times those achieved by systemic administration are obtained. MethodsTechniques for hyperthermic perfusion were developed for limbs, pelvis, head, neck, and skin of the breast. Melphalan (Burroughs Wellcome, Research Triangle Park, NC) was used in 753 patients. Combinations with melphalan or other drugs were used in remaining cases at temperature of 38 to 40 C for 30 to 60 minutes. ResultsChemotherapy perfusion followed by tumor excision or node dissection, was performed where indicated. The cumulative 1 0-year survival for patients with localized melanomas was 70%. For patients with local recurrences or satellites within 3 cm, survival was 61 %. For those with regionally confined intransit tumors, survival was 30%; for those with regional node involvement, 38%; for those with intransit and nodal metastases, 16%; for those with distant metastases and perfusion-mainly to save functional limbs-survival was 7%. Multiple perfusions were performed in 158 patients with recurrent disease on 366 occasions. Patients with indolent regionally confined melanomas were benefited by prolongation of useful life. ConclusionsSafe perfusion techniques are available for most anatomic regions. Increased chemotherapeutic doses are delivered to isolated areas limited only by local toxicity. Adjunct perfusion in poor prognosis stage cases is useful in reducing local recurrence, and intransit or lymph node metastases. Regional perfusion reduces the need for major amputation. Multiple perfusion can be useful in treating recurrent chronic melanoma. 520

Long Term Outcome of Preoperative Isolated Limb Infusion and External Irradiation in Management of Locally Advanced Extremity Soft Tissue Sarcoma

“…It has been traditionally carried out using a procedure called isolated limb perfusion (ILP), first developed in New Orleans in the mid-1950s [9]. The technique was based on the proposal that vascular isolation and perfusion of the extremity with chemotherapy would allow regional drug concentrations several orders of magnitude higher than could be attained with systemic administration.…”

Consideraciones perioperatorias en el paciente oncológico sometido a perfusión aislada de la extremidad

“…El desarrollo de técnicas de quimiofiltración ha permitido que el paso de sangre venosa a través de un filtro remueva el exceso de fármacos y evite efectos tóxicos locales y la posibilidad de efectos sistémicos en regiones anatómicas que son difíciles de aislar en su totalidad 9,33 . Aun así, la detección de fugas hacia la circulación sisté-mica es primordial, y para ello se utiliza albúmina marcada con iodo 131 o eritrocitos marcados con tecnecio 99 y una gamma sonda o gamma cámara en la región precordial.…”

“…Desde entonces, se ha utilizado exitosamente en el tratamiento de las neoplasias de localización en las extremidades, como los sarcomas de tejidos blandos y el melanoma [6][7][8][9][10][11] , aunque también se ha descrito en tumores de otra localización como el hígado, el estómago y colon, la pelvis, la región maxilofacial, y la cabeza y cuello [12][13][14][15][16] . En la actualidad, no sólo se perfunden agentes quimioterápicos (v.…”

Defining regional infusion treatment strategies for extremity melanoma: comparative analysis of melphalan and temozolomide as regional chemotherapeutic agents

“…Regional therapy in the form of either isolated limb perfusion or isolated limb infusion (ILI) has become an increasingly favored treatment for melanoma patients with intransit disease that is not amenable to simple surgical excision (1,2). Regional therapy can yield drug concentrations f10-fold higher than those achieved in systemic therapy while minimizing toxicity.…”