Hyperthermic adjuvant perfusion chemotherapy for stage I malignant melanoma of the extremity with literature review

Rege, Vishram B.; Leone, Louis A.; Soderberg, Clarence H.; Coleman, George V.; Robidoux, Henry J.; Fijman, Ruben; Brown, Jeanne

doi:10.1002/1097-0142(19831201)52:11<2033::aid-cncr2820521111>3.0.co;2-f

Cited by 43 publications

(4 citation statements)

References 20 publications

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“…To avoid or minimize systemic toxicity, Creech and associates [6] perfused the tumor-bearing extremity regionally with cytostatic agents utilizing a perfusion aggregate. Since then, regional perfusion has been added to conventional therapy and, as has been demonstrated in several retrospective studies, has achieved good results [7][8][9][10].…”

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confidence: 96%

Hyperthermic perfusion with chemotherapy for melanoma of the extremities

et al. 1989

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A prospective randomized study was carried out to evaluate the effectiveness of additional regional cytostatic perfusion of the extremities in patients with malignant melanoma. In a control group (n = 54), the tumors were widely excised, and regional lymph nodes were dissected. The patients in the perfusion group (n = 53) received additional hyperthermic (42 degrees C) perfusion with Melphalan. The disease-free survival time was chosen as the criterion for evaluation. An intermediate analysis revealed a highly significant difference between the 2 groups (21 recurrences in the control group and 4 recurrences in the perfusion group, p less than 0.001). Therefore, the study was discontinued prematurely. In an analysis of the data performed after a median observation time of 5 years and 11 months, 26 recurrences were diagnosed in the control group, whereas 6 recurrences were noted in the perfusion group (p less than 0.001). The retrospective breakdown into different risk groups according to tumor thickness also demonstrates a significant difference. For patients with a primary tumor of 1.5-3.0-mm in thickness, 2 of 25 in the perfusion group and 10 of 25 in the control group have relapsed. For those with a primary tumor of greater than 3.0-mm in thickness, 4 of 28 in the perfusion group and 16 of 29 in the control group have relapsed. Eleven patients in the control group and 3 patients in the perfusion group have died due to metastatic spread of the melanoma (p less than 0.01). The results most clearly demonstrate the benefits of additional hyperthermic cytostatic perfusion.

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confidence: 96%

Hyperthermic perfusion with chemotherapy for melanoma of the extremities

et al. 1989

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“…Metastatic nodules are not immediately removed after the perfusion, but only at the time of the presumed maximum reduction (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) days after HAP), assuming that the treatment did not lead to a complete response (CR). Adjuvant systemic chemotherapy has never been employed, while immunomodulating treatment [i.e., with bacillus Calmette-Gukrin (BCG), interferon (IFN)] has been nonproductive, and has been abandoned.…”

Section: Methodsmentioning

confidence: 99%

Hyperthermic antiblastic perfusion in the treatment of local recurrence or “In‐transit” metastases of limb melanoma

Cavaliere¹,

Filippo²,

Giannarelli

et al. 1992

Seminars in Surgical Oncology

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On the basis of personal experience and a review of the literature, the authors have evaluated the results obtained with hyperthermic antiblastic perfusion (HAP) for the treatment of stage II, III and IIIAB limb melanoma. The evaluation showed that today HAP may be considered a safe and effective treatment, with a major complication rate ranging between 1% and 4%. In terms of tumor response, locoregional control and survival, this treatment has provided better results than other regional chemotherapeutic modalities and undoubtedly better results than those obtained with conventional, even radical, surgery. The multiparametric analysis showed that, of the treatment-related prognostic factors, the minimum tumor temperature influenced the percentage of complete response (CR) to the greatest extent (P < 0.03), with a positive trend also with regard to the dosage of the antiblastic drug employed (P < 0.08). In turn, the complete response rate was a determinant as far as locoregional control (75.3%; P < 0.0009) and disease-free (51.4%; P < 0.009) and overall survival (63.2%; P < 0.009) rates were concerned. Of the tumor-related prognostic factors, the number of lesions (P < 0.0014), sex (P < 0.04), and the number of disease recurrences (P < 0.01) appear to influence overall survival.

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“…There are numerous institutional reviews reporting limb recurrence rates and overall survival in patients with Stage I and resected Stage IVIII extremity melanoma after adjuvant ILP compared to historical matched controls (Table 11) [34][35][36][37][38][39][40][41][42][43]. In general, these studies include a mixed group of patients, and interpretation of survival data using nonrandomized controls is difficult because prognostically significant variables including age, gender, regional nodal status, or number and location of in-transit lesions are not known [5,26,44].…”

Section: Adjuvant Melphalan Isolated Limb Perfusionmentioning

confidence: 99%

Isolated limb perfusion for malignant melanoma

Alexander¹,

Fraker²,

Bartlett³

1996

Semin. Surg. Oncol.

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The technique of isolated limb perfusion (ILP) for the treatment of extremity melanoma has been used in the United States for almost 40 years. The treatment is based upon the ability to isolate the circulation of the afflicted extremity from the systemic circulation, thereby allowing dose‐intensive delivery of anti‐cancer agents to the limb while eliminating systemic exposure and toxicity. A number of agents have been used in ILP, however, the bulk of clinical experience has been with the alkylating agent melphalan, typically used under conditions of mild hyperthermia. Despite considerable clinical experience, there has been a lack of agreement about the role of ILP in the prophylaxis against or the treatment of recurrent extremity melanoma. Recently there has been renewed interest in the use of ILP based upon the very promising results using a combination of tumor necrosis factor, melphalan, and interferon‐gamma which have produced complete response (CR) rates of almost 90%. The utility of this regimen in extremity melanoma is actively being evaluated by clinical trials in the United States and Europe. © 1996 Wiley‐Liss, Inc.

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Hyperthermic adjuvant perfusion chemotherapy for stage I malignant melanoma of the extremity with literature review

Cited by 43 publications

References 20 publications

Hyperthermic perfusion with chemotherapy for melanoma of the extremities

Hyperthermic perfusion with chemotherapy for melanoma of the extremities

Hyperthermic antiblastic perfusion in the treatment of local recurrence or “In‐transit” metastases of limb melanoma

Isolated limb perfusion for malignant melanoma

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