ILP with TNF, IFN, and melphalan is a safe and highly effective induction biochemotherapy procedure that can achieve limb salvage in patients with nonresectable extremity STS. TNF is an active anticancer drug in humans in the setting of ILP.

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Genetic testing enables women at risk for hereditary breast and/or ovarian cancer to find out whether they have inherited the gene mutation (BRCA1/BRCA2), and if so, to opt for frequent surveillance and/or prophylactic surgery (bilateral mastectomy and/or oophorectomy). Here, a follow-up is described for 63 healthy women at 50% risk of being a BRCA1/BRCA2 mutation carrier who underwent genetic testing. The course of distress and problems regarding body image and sexuality up to 1 year after disclosure of the test-outcome were described separately for mutation carriers undergoing mastectomy (n = 14), for mutation carriers opting for surveillance (n = 12) and for non-mutation carriers (n = 37). Furthermore, we analyzed whether women opting for prophylactic mastectomy differed from those opting for close surveillance with respect to biographical characteristics, experiences with cancer in relatives and personality. Women opting for prophylactic mastectomy had significantly higher distress levels than mutation carriers who opted for surveillance, and the non-mutation carriers. This difference in levels of distress was highest at pre- and post-test and had almost disappeared at 1-year follow-up. Besides, mutation carriers opting for prophylactic mastectomy were more often in their thirties, more often had young children and had a longer awareness of the genetic nature of cancer in the family than those opting for regular surveillance. Adverse effects were observed in women who underwent prophylactic mastectomy (mostly in combination with immediate breast reconstruction) regarding the perception of how their breast region looked like and felt, the intimate relationship and physical wellbeing whereas women opting for prophylactic mastectomy reported more distress than the other women in the study, their distress levels had significantly decreased 6 months or longer after surgery, possibly due to the significant risk reduction of developing breast cancer. This might explain, why most women who underwent prophylactic mastectomy were satisfied with this decision, despite a perceived negative impact on body image, the intimate relationship and physical wellbeing.

Prognosis of patients with metastatic melanoma is poor (Ketcham and Balch, 1985;Tafra et al, 1995), with an annual risk of death of about 20% during the first 3 years (Slingluff et al, 1992). The second most common site for metastatic spread is the lung (Balch and Milton, 1985), and the annual probability of developing pulmonary metastases increases progressively from 10% at 5 years to 17% at 15 years. Overall long-term survival for such patients is poor, with only 4% of patients alive at 4 years (Harpole et al, 1992).As effective chemotherapy for metastatic melanoma is not available, surgery can represent the only prospect of cure for highly selected patients (Wong et al, 1993;Karakousis et al, 1994). However only 10-12% of cases are suitable for surgery with curative intent (Cahan, 1973;Mountain et al, 1984;Thayer and Overholt, 1985;Pogrebniak et al, 1988;Gorenstein et al, 1991). Moreover, surgical results are still controversial as the majority of published studies are based on a small number of cases with relatively short follow-up.Two large series have already confirmed the prognostic value of factors such as radicality, number of resected metastases and disease-free interval (DFI) after pulmonary metastasectomy (Harpole et al, 1992;Tafra et al, 1995) but it remains unclear how these data can be used for preoperative patient selection.The purpose of this study is to evaluate the long-term results of surgery in melanoma pulmonary metastases from the International Registry of Lung Metastases (IRLM) data, with the aim of defining the subset of patients that really benefit from surgery. PATIENTS AND METHODSOf the 5206 patients recorded in the International Registry of Lung Metastases in the period 1945-1995, 328 (6.3%) had operations for pulmonary stage IV melanoma. The aims of the Registry, methodology of data collection and analysis have been published previously (Pastorino et al, 1997). In summary, all patients who had undergone resection of pulmonary metastases with curative intent were eligible for inclusion if their primary tumour, as well as metastases in other organs, had been effectively treated. Eighteen major centres from Europe, the USA and Canada took part in the project. Data analysisSurvival time was calculated from first metastasectomy to the last date of follow-up, by means of the Kaplan-Meier estimate. Mean follow-up of patients alive was 42 months.The impact on survival of the following variables was tested: age, sex, radicality of metastasectomy, time to pulmonary metastases (time from surgery of primary melanoma to diagnosis of pulmonary metastases, TPM), number of pathologically confirmed metastases, resection volume, nodal involvement, delay of surgery from diagnosis of metastases to metastasectomy, chemotherapy, Lung metastases from melanoma: when is surgical treatment warranted? Summary Surgical treatment of lung metastases from melanoma is highly controversial as the expected outcome is much poorer than for other primary tumours and a reliable system for selecting patients is lacking. ...