Rizell Magnus, Mattson Jan, Cahlin Christian, Hafström Larsolof, Lindner Per, Olausson Michael
Department of Surgery, Transplantation and Liver Surgery Service, Sahlgrenska University Hospital, Gothenburg, Sweden.
Melanoma Res. 2008 Apr;18(2):120-6. doi: 10.1097/CMR.0b013e3282f8e3c9.
The objective was to analyze the outcome of three treatment strategies using isolated hyperthermic liver perfusion (IHP) with melphalan for liver metastases of malignant melanoma. It was designed as an exploratory study. The setting was a single-center study in a university hospital. The study was carried out on 27 patients. IHP was used with modifications during three different time periods (IHP I, IHP II and IHP III), in technique and temperature (amount of melphalan: 0.5, 1.0 and 2 mg/kg body weight in the perfusate; 41, 40 and 40 degrees C). Tumor response was estimated according to WHO criteria with computed tomography or MRI. Mortality and morbidity were secondary measures. Six of 11 patients in the IHP I cohort experienced a partial response (PR). In the IHP II cohort, two patients of 11 experienced a complete response and five a PR. In the IHP III cohort, five of five patients experienced a PR. Six postoperative deaths were reported (27%) (three in the IHP I and three in the IHP II series), secondary to liver insufficiency and multiorgan failure. Treatment of liver metastases of malignant melanoma with isolated hyperthermic melphalan perfusion has shown an impressive tumor response rate, which seems to be higher than the response rates reported for other systemic chemotherapy regimens. The maximum tolerated dose for melphalan in the perfusate was surpassed with a 2 mg/kg body weight. By modifying the technique and restricting the allowed tumor burden, the response rate remained high and the mortality was reduced.
目的是分析采用美法仑隔离热灌注（IHP）治疗恶性黑色素瘤肝转移的三种治疗策略的结果。该研究设计为探索性研究。研究地点为一所大学医院的单中心研究。该研究对27例患者进行。在三个不同时间段（IHP I、IHP II和IHP III）对IHP进行了技术和温度方面的改进（灌注液中美法仑剂量：0.5、1.0和2mg/kg体重；温度：41、40和40摄氏度）。根据WHO标准，采用计算机断层扫描或磁共振成像评估肿瘤反应。死亡率和发病率为次要指标。IHP I队列的11例患者中有6例出现部分缓解（PR）。在IHP II队列中，11例患者中有2例出现完全缓解，5例出现PR。在IHP III队列中，5例患者全部出现PR。报告了6例术后死亡（27%）（IHP I系列3例，IHP II系列3例），继发于肝功能不全和多器官功能衰竭。采用美法仑隔离热灌注治疗恶性黑色素瘤肝转移显示出令人印象深刻的肿瘤反应率，似乎高于其他全身化疗方案报告的反应率。灌注液中美法仑的最大耐受剂量在2mg/kg体重时被超过。通过改进技术并限制允许的肿瘤负荷，反应率保持较高，死亡率降低。
