The use of regional chemotherapy in the management of malignant melanoma

• Published in: World journal of surgery 1979-05, Vol.3 (3), p.289-302
• Main Authors: Krementz, Edward T., Carter, R. Davilene, Sutherland, Carl M., Campbell, Marilyn
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents - administration & dosage; Chemotherapy, Cancer, Regional Perfusion - methods; Female; Humans; Improve Survival Rate; Infusions, Intra-Arterial - methods; Male; Melanoma; Melanoma - drug therapy; Nous Avons; Regional Disease; Skin Neoplasms - drug therapy; Systemic Chemotherapy
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/BF01556579

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. Excisional 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 isolation‐perfusion. 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. Résumé Entre 1957 et 1977, nous avons traité 714 malades atteints de mélanome malin par chimiothérapie en perfusion régionale du membre isolé, et 56 malades par perfusion intra‐artérielle. Pour 286 cas au stade I, la chirurgie d'exérèse associée à la perfusion régionale a donné des survies cumulatives de 87% à 5 ans et de 75% à 10 et 15 ans. Pour les récidives locales ou métastases régionales traitées par perfusion seule ou associée à la chirurgie, les survies ont été de 36% à 5 ans, 34% à 10 ans et 31% à 15 ans. Même pour le groupe le moins favorable, de cas avec envahissement des ganglions et des tissus mous, les survies ont été de 27% à 5 an