The use of regional chemotherapy in the management of malignant melanoma

Abstract

From 1957 through 1977, a total of 714 patients with malignant melanoma were treated by chemotherapy administered by isolated regional perfusion of the limbs, and 56 patients were treated by intra-arterial infusion.Excisionai surgery and adjunctive perfusion in 286 patients with stage I disease resulted in cumulative survival rates of 87% at 5 years and 75% at 10 and 15 years. With recurrent or metastatic regional disease treated by perfusion alone or in combination with surgical excision, the survival rates were 36%, 34%, and 31% at 5, 10, and 15 years, respectively. Even in the least favorable group, those with nodal and soft tissue involvement, the survival rates were 27% at 5 years and 22.5% at 10 and 15 years. Analysis of 121 patients with stage I melanoma according to level of dermal invasion showed recurrence in 2 of 42 (4%) patients with level III lesions, 11 of 75 (15%) with level IV tumors, and 2 of 4 (50%) with level V lesions. Recurrence rates by pathologic type were 2 of 49 (4%) patients with superficial spreading melanoma, 6 of 30 (20%) with nodular melanoma, and 5 of 14 (36%) with acral lentiginous melanoma, the latter including subungual, plantar, or palmar lesions.Chemotherapy by intra-arterial infusion is a technique useful in treating regional disease not amenable to isolationperfusion. Of 36 patients having measurable lesions, there were 4 complete responses. Objective responses occurred in 50-80% of patients treated, depending on the agent used.As an adjunct to surgical treatment, Chemotherapy by isolation-perfusion offers improved survival rates without prolonged treatment or the risks associated with systemic chemotherapy. As primary therapy for advanced regional disease, chemotherapy by perfusion produces survival rates superior to those obtained by surgery alone or systemic chemotherapy.

Miniature equipment for the perfusion of rat limbs

“…Although the technique of isolated limb perfusion in humans, inaugurated by Creech et al and supplemented with hyperthermia by Stehlin et al has been employed in cancer chemotherapy for several years [14,15,19], controlled studies using this approach are rare. In the human, variables, such as staging and histological type of tumors, interfere with the attainment of precise information.…”

Isolated regional perfusion; anaesthetic technique, monitoring and blood replacement

“…The flows we utilize comply with those flows described by authors from other institutions. [17][18][19] We did not systemically heparinize our patients unless there was an indication to do so. This would include a prolonged perfusion time (we consider this to he greater than one hour) as well as other medically indicated uses of systemic heparinization.…”

Construction and Validation of a Microprocessor Controlled Extracorporal Circuit in Rats for the Optimization of Isolated Limb Perfusion

“…To halt the rapid raise of blood pressure caused by reflex vasoconstriction in the hind limb of © 2004 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim the rat, a spasmolytic agent must be added to the perfusate. It is noteworthy that spasmolytics are usually not administered in ILP to human patients [39,40]. With the administration of moxaverine, blood pressure could be stabilized rapidly within the physiological range (40Ϫ60 mm Hg) and maintained at a very constant value during the whole perfusion period without any changes in blood flow.…”