Frequency and duration of remission after isolated limb perfusion for melanoma
J. F. Thompson, J. A. Hunt, K. F. Shannon and P. C. Kam
Sydney Melanoma Unit, Royal Prince Alfred Hospital, Australia. john@mel.rpa.cs.nsw.gov.au
OBJECTIVE: To examine the frequency and duration of complete remission for
locally recurrent and metastatic limb melanoma after isolated limb
perfusion (ILP) with cytotoxic agents. DESIGN: A case series of 114
consecutive therapeutic ILPs performed between April 1984 and April 1994
and a review of previously published studies. SETTING: A tertiary referral
center for melanoma treatment, located at a university teaching hospital.
RESULTS: Of 111 assessable ILPs, 81 (73%) resulted in complete limb tumor
remission and 14 (13%) resulted in partial remission (defined as a
reduction in size of tumor deposits by > 50%). Complete remission was
maintained in 37 (46%) of the 81 cases without any further treatment
(median follow-up, 33 months; range, 8-112 months). Of the other 44 cases,
disease subsequently recurred in the perfused limb (median time to
recurrence, 9.5 months; range, 2-65 months). In 19 of these cases, however,
the limb was again disease free at last follow-up after local surgery (12
cases) or a repeat ILP (7 cases). Overall, complete locoregional control
was achieved after 50% of assessable ILPs, and a long-term disease-free
state in the limb was achieved, with or without further treatment, in 56
(69%) of the 81 cases in which an initial complete remission occurred. For
743 therapeutic ILPs undertaken in 12 series previously reported in the
literature, an initial complete remission was reported in 50% of these
cases and partial remission in 32%. CONCLUSION: Therapeutic ILP is an
effective form of treatment for patients with recurrent and metastatic limb
melanoma, achieving short- and long-term results that are superior to those
achievable by any other form of treatment currently used.
