Efficacy of hyperthermic isolated limb perfusion for extremity-confined recurrent melanoma

Recurrent melanoma of the extremity has been treated by local excision, systemic chemotherapy, amputation, or a combination of these approaches. Hyperthermic isolated limb perfusion (HILP) provides a method of limb preservation through isolation, allowing the administration of chemotherapy in higher...

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Bibliographic Details
Published in:Annals of surgical oncology 1998-06, Vol.5 (4), p.376-383
Main Authors: Brobeil, A, Berman, C, Cruse, C W, De Conti, R, Cantor, A, Lyman, G H, Joseph, E, Rapaport, D, Wells, K, Reintgen, D S
Format: Article
Language:English
Subjects:
Amputation
Antineoplastic Agents - administration & dosage
Antineoplastic Agents - therapeutic use
Chemotherapy
Extremities
Female
Humans
Hyperthermia, Induced
Male
Medical prognosis
Melanoma
Melanoma - secondary
Melanoma - therapy
Melphalan
Metastases
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local
Perfusion
Perfusion - methods
Preservation
Prospective Studies
Survival
Survival Analysis
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Summary:Recurrent melanoma of the extremity has been treated by local excision, systemic chemotherapy, amputation, or a combination of these approaches. Hyperthermic isolated limb perfusion (HILP) provides a method of limb preservation through isolation, allowing the administration of chemotherapy in higher doses than is possible through systemic treatment. An experimental group of 59 HILP patients with melanoma recurrences of the extremity was studied prospectively. A control group of 248 melanoma patients with similar recurrences was excluded from HILP because their recurrences were in non-extremity locations. The experimental group underwent HILP and excision; the control group had excision only. The experimental procedure consisted of vascular isolation of the affected extremity and a 1-hour perfusion with melphalan. Temperatures were maintained at 40 degrees C in the perfusion circuit. The HILP patients had a lower rate of locoregional recurrence (P=.028) and demonstrated increased survival (P=.026) compared to the control group. In multivariate regression analysis, which included age, ulceration and thickness of the primary, and the treatment variable of perfusion, age (P=.02) and perfusion for the treatment of recurrence (P=.006) were significant predictors of survival. HILP improves prognosis by sterilizing the treated extremity, controlling locoregional disease, and perhaps preventing metastasis, thus having a positive impact on overall survival.
ISSN:1068-9265
1534-4681
DOI:10.1007/BF02303503