Takkenberg R B, Vrouenraets B C, van Geel A N, Nieweg O E, Noorda E M, Eggermont A M M, Kroon B B R
Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands.
J Surg Oncol. 2005 Aug 1;91(2):107-11. doi: 10.1002/jso.20297.
Two to three percent of the patients with extremity melanoma develop in-transit metastases in the course of their disease. When local treatments fail, isolated limb perfusion (ILP) is a reasonable option, but is generally only applied to patients without evidence of distant metastases. We assessed the value of ILP in stage IV melanoma patients with symptomatic unresectable limb melanoma at our institutions.
A computerized database, containing all patient, tumor, ILP, and follow-up data of 505 ILPs performed in 451 patients between 1978 and 2001, allowed the selection of eight (1.8%) stage IV patients who underwent a palliative ILP for unresectable melanoma lesions on the limbs. All patients had high tumor burden limb disease, according to the combined Fraker and Rossi criteria.
The overall tumor response rate was 88%, with 13% complete and 75% partial response rates. One patient did not respond to ILP. Three partial responding patients attained a complete remission (CR) after excision of the remaining limb lesions. The median duration of hospital stay was 12 days and acute regional toxicity was mild with slight erythema and edema in six and no signs of reaction in two patients. The median limb recurrence-free interval after CR was 6 months and the median duration from the time of distant metastases to death was 15 months. Overall ILP leads to the desired palliative effect in six patients (75%).
ILP should be considered as a palliative treatment in selected stage IV melanoma patients with symptomatic advanced limb disease.
2%至3%的肢体黑色素瘤患者在疾病过程中会发生移行转移。当局部治疗失败时，孤立肢体灌注（ILP）是一种合理的选择，但通常仅适用于无远处转移证据的患者。我们评估了ILP在我们机构中对有症状的不可切除肢体黑色素瘤的IV期黑色素瘤患者的价值。
一个计算机化数据库包含了1978年至2001年间451例患者进行的505次ILP的所有患者、肿瘤、ILP和随访数据，从中选出了8例（1.8%）IV期患者，他们因肢体不可切除的黑色素瘤病变接受了姑息性ILP。根据Fraker和Rossi联合标准，所有患者的肢体疾病肿瘤负荷都很高。
总体肿瘤缓解率为88%，其中完全缓解率为13%，部分缓解率为75%。1例患者对ILP无反应。3例部分缓解的患者在切除剩余肢体病变后达到完全缓解（CR）。中位住院时间为12天，急性局部毒性较轻，6例患者有轻微红斑和水肿，2例患者无反应迹象。CR后肢体无复发生存期的中位数为6个月，从远处转移到死亡的中位持续时间为15个月。总体而言，ILP使6例患者（75%）获得了预期的姑息效果。
对于有症状的晚期肢体疾病的特定IV期黑色素瘤患者，应考虑将ILP作为一种姑息治疗方法。
