Isolated limb perfusion for localized melanoma of the extremity. A matched comparison of wide local excision with isolated limb perfusion and wide local excision alone
M. J. Edwards, S. J. Soong, A. W. Boddie, C. M. Balch and C. M. McBride
Department of General Surgery, University of Texas, M.D. Anderson Cancer Center, Houston.
The therapeutic efficacy of isolated limb perfusion in patients with
localized melanoma of the extremity remains controversial. We compared
patients treated at the University of Texas M.D. Anderson Cancer Center,
Houston, with wide local excision and isolated limb perfusion using either
melphalan or imidazole carboxamide with a group matched for prognostic
factors from the University of Alabama at Birmingham and the University of
Sydney (Australia) who were treated with wide local excision alone. No
significant difference in disease-free or overall survival rates was found
between patients treated with wide local excision with adjuvant isolated
limb perfusion or wide local excision alone. However, a subset of patients
with thicker lesions (greater than 2.0 mm) treated with wide local excision
and isolated limb perfusion using melphalan had a significant improvement
in both disease-free and overall survival rates. These data suggest that
isolated limb perfusion using melphalan may improve survival rates in
selected patients with localized melanoma of the extremity who are at
increased risk for local and regional micrometastases, and justifies the
continued study of this treatment approach in prospective clinical trials.
