Results of isolated lower limb perfusion for loco‐regional advanced/recurrent melanoma using borderline true hyperthermia plus additional bolus of melphalan. A critical analysis of homogeneous cases

Pace, M; Gattai, Riccardo; Mascitelli, E.; Millanta, L.M.

doi:10.1002/jso.21949

Cited by 5 publications

(6 citation statements)

References 33 publications

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“…The median time to local progression (TTLP) for patients with CR was 18 months (range: 10–23.8 months) [ 30 , 31 , 36 , 38 , 41 , 42 ], with a median of 5.7 months (range: 4–14 months) for patients with RP [ 30 , 31 , 37 , 41 ]. Both Madu et al, and Rossi et al, observed statistically significant differences for the LPFS of patients who presented with CR vs. those who did not ( p < 0.001 and p < 0.0001, respectively).…”

Section: Resultsmentioning

confidence: 99%

“…Five studies provided valid results on the time to systemic progression (TTSP) [ 24 , 36 , 38 , 39 , 40 ], with a median of 10.75 months (range: 7.5–19.7) for the general population. TTSP did not differ between patients receiving a single ILP (12 months) and multiple ILPs (15 months; p = 0.27) [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

“…Five studies [ 34 , 35 , 36 , 38 , 39 ] reported survival data stratified by the tumor stage. Stage IIIA (lymph node micrometastases in the previous AJCC staging system) was associated with a better survival in several studies.…”

Section: Resultsmentioning

confidence: 99%

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Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature

Sevilla-Ortega

Ferrandiz‐Pulido

Palazón‐Carrión

et al. 2021

Cancers

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Background. Isolated limb perfusion (ILP) is a locoregional procedure indicated by the unresectable melanoma of the limbs. Its complexity and highly demanding multidisciplinary approach means that it is a technique only implemented in a few referral centers around the globe. This report aims to examine its potential role in the era of targeted therapies and immunotherapy by conducting a systematic review of the literature on ILP. Methods. PubMed, Embase and Cochrane Library were searched. The eligibility criteria included publications from 2000–2020 providing valid data o effectiveness, survival or toxicity. Studies in which the perfusion methodology was not clearly described, letters to the editor, non-systematic reviews and studies that applied outdated clinical guidelines were excluded. To rule out studies of a low methodological quality and assess the risk of bias, the following aspects were also required: a detailed description of the applied ILP regimen, the clinical context, follow-up periods, analyzed clinical endpoints, and the number of analyzed ILPs. The disagreements were resolved by consensus. The results are presented in tables and figures. Results. Twenty-seven studies including 2637 ILPs were selected. The median overall response rate was 85%, with a median complete response rate of 58.5%. The median overall survival was 38 months, with a 5-year overall survival of 35%. The toxicity was generally mild according to Wieberdink toxicity criteria. Discussion. ILP still offer a high efficacy in selected patients. The main limitation of our review is the heterogeneity and age of most of the articles, as well as the absence of clinical trials comparing ILP with other procedures, making it difficult to transfer its results to the current era. Conclusions. ILP is still an effective and safe procedure for selected patients with unresectable melanoma of the limbs. In the era of targeted therapies and immunotherapy, ILP remains an acceptable and reasonable palliative treatment alternative, especially to avoid limb amputations. The ongoing clinical trials combining systemic therapies and ILP will provide more valuable information in the future to clarify the potential synergism of both strategies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature

Sevilla-Ortega

Ferrandiz‐Pulido

Palazón‐Carrión

et al. 2021

Cancers

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“…During ILP, regional hyperthermia is associated to chemotherapy , in order to augment the effects of the drug and to prevent vasoconstriction of cutis and subcutis. This can be easily achieved using the vascular isolation of the limb.…”

Section: Limb Perfusionmentioning

confidence: 99%

Alternatives for the treatment of local advanced disease: electrochemotherapy, limb perfusion, limb infusion, intralesional IL2. What is the role?

et al. 2012

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Nowadays, melanoma is one of the most common fatal malignancy of young adults. Incidence is increasing, but mortality rates from melanoma have remained stable. In-transit metastases from extremity or trunk melanoma are subcutaneous or cutaneous deposits of melanoma distant from the primary site, but not reaching the draining nodal basin. According to American Joint Committee on Cancer classification of stages based on Tumor, Node, Metastases classification stages IIIb and IIIc are considered local advanced disease and survival outcomes is quite poor, with 5-year survival rates of 24-54%. Loco-regional recurrence is an important risk factor for distant metastatic disease, either synchrone or metachrone. Therapy for this pattern of recurrence is limited and options vary based on the volume and site of disease. Definitive surgical resection remains the preferred therapeutic approach. However, when surgery cannot be performed with a reasonable cosmetic and functional outcome, other options must be utilized. Treatment options are classified as local, regional, or systemic. The choice of therapy depends on the number of lesions, their anatomic location, whether or not they are dermal or subcutaneous, the size, and the presence or absence of extra-regional disease.

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“…As a superficial tumor, melanoma can easily be administered local hyperthermia from the clinical point of view. Either as a monotherapy or as an adjuvant therapy with other treatments, such as chemotherapy or radiotherapy, the results of hyperthermia treatment from clinical trials and in vivo studies are encouraging, suggesting a promising protocol for malignant melanoma (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Antitumor effect and immune response induced by local hyperthermia in B16 murine melanoma: Effect of thermal dose

Tang

Zhao

et al. 2012

Oncology Letters

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Abstract. This study aimed at investigating the antitumor effect and immune response induced by local high-temperature hyperthermia at different thermal doses in B16 murine melanoma. The screened optimal thermal dose (50˚C, 15 min) which was demonstrated to be the most effective in immune response activation was applied to the treatment of lung metastasis. The optimal thermal dose was determined by evaluating the tumor volume change, survival period of tumorbearing mice, and immune indices including interleukin (IL)-2, interferon (IFN)-γ and TNF-α mRNA expression in the spleen of mice subjected to local hyperthermia at various thermal doses. The activation of the immune response was further investigated by rechallenging the cured mice 60 days after hyperthermia treatment. The screened optimal thermal dose combined with immunoadjuvant compound 48/80 was applied for melanoma lung metastasis. While local hyperthermia effectively inhibited B16 melanoma tumor growth and prolonged the survival period of tumor-bearing mice, the antitumor immunity was significantly enhanced and the effect was thermal dose-dependent. Higher temperatures (≥50˚C) induced a significant effect even with a short treatment time (≤15 min). No tumor regrowth was observed for rechallenged B16 melanoma in mice following treatment with local hyperthermia at a higher temperature. Local hyperthermia by optimal thermal dose in combination with immunoadjuvant compound 48/80 is an effective approach for the treatment of B16 melanoma lung metastasis. This study indicated that the use of a local high-temperature hyperthermia protocol inhibits tumor growth and stimulates a favorable antitumor immune response against malignant melanoma. The results of these experiments may have clinical significance for the treatment of melanoma.

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Results of isolated lower limb perfusion for loco‐regional advanced/recurrent melanoma using borderline true hyperthermia plus additional bolus of melphalan. A critical analysis of homogeneous cases

Abstract: Our procedure is an important therapeutic option. The results suggest a marked local control of the recurrent disease. The LRFI is longer than for those treated with other treatment schedules.

Cited by 5 publications

References 33 publications

Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature

Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature

Alternatives for the treatment of local advanced disease: electrochemotherapy, limb perfusion, limb infusion, intralesional IL2. What is the role?

Antitumor effect and immune response induced by local hyperthermia in B16 murine melanoma: Effect of thermal dose

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