Long-term morbidity after regional isolated perfusion with melphalan for melanoma of the limbs. The influence of acute regional toxic reactions
B. C. Vrouenraets, J. M. Klaase, B. B. Kroon, B. N. van Geel, A. M. Eggermont and H. R. Franklin
Department of Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Huis), Amsterdam.
OBJECTIVE: To determine the influence of acute regional toxic reactions on
the incidence and characteristics of long-term morbidity after regional
isolated perfusion with melphalan. DESIGN: Retrospective study. SETTING:
The Amsterdam and Rotterdam perfusion centers, the Netherlands. PATIENTS:
All patients with melanoma who were treated between 1978 and 1990 and had a
minimum follow-up of 1 year after perfusion (n = 367). INTERVENTION:
Fifty-four patients (15%) had perfusion of the upper limb, 313 (85%) had
perfusion of the lower limb, and 164 patients (45%) underwent regional
lymph node dissection at the time of perfusion. MAIN OUTCOME MEASURE:
Incidence and characteristics of morbidity 1 year after perfusion and the
influence of acute regional toxic reactions on long-term morbidity.
RESULTS: One hundred sixty patients (44%) showed some degree of objective
or subjective morbidity; most (104 [28%]) had lymphedema. Other long-term
morbidity consisted of muscle atrophy or fibrosis (42 [11%]), limb
malfunction (55 [15%]), neuropathy (13 [4%]), pain (28 [8%]), and recurrent
infection (11 [3%]). Miscellaneous complications were seen in 14 patients
(4%). Seventy-one patients (19%) had more than one complication. Acute
regional toxic reactions had a statistically significant effect on the
incidence of long-term morbidity (P < .01). Moderate to severe acute
regional toxic reactions were strongly linked to the occurrence of muscle
atrophy or fibrosis (P < .001) and limb malfunction (P < .001).
Regional lymph node dissection was statistically significantly related to
lymphedema (P = .05). CONCLUSION: Improvement of the perfusion technique
should be pursued in an effort to reduce acute regional toxic reactions,
and thereby long-term morbidity, without compromising the therapeutic
effect.
