Kroon Hidde M, Lin D-Yin, Kam Peter C A, Thompson John F
Sydney Melanoma Unit and Melanoma Institute Australia, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia.
Ann Surg Oncol. 2009 May;16(5):1193-201. doi: 10.1245/s10434-009-0326-7. Epub 2009 Feb 18.
In the treatment of patients with advanced limb melanoma a major treatment dilemma can arise when distant metastases are present also. Isolated limb infusion (ILI) has proved to be a useful limb-saving treatment and could potentially be of palliative value in patients with American Joint Committee on Cancer (AJCC) stage IV melanoma.
We identified 37 patients with advanced symptomatic limb disease as well as documented distant metastases at the time of their ILI. In all patients a drug combination of melphalan and actinomycin D was used.
Fifty one percent had visceral distant metastases and 49% had cutaneous distant metastases only. The overall response rate in the treated limb was 76% [complete response (CR) rate 22%, partial response (PR) rate 54%]. Median response duration was 11 months (28 months for patients with CR; p = 0.08). Median survival after CR was 22 months, 17 months after PR, and only 4 months for those with stable or progressive disease (p = 0.002). Patients with visceral distant metastases had a significantly decreased survival compared with those with cutaneous distant metastases only (8 and 21 months, respectively; p = 0.03). Limb salvage was achieved in 86% of the patients. The procedure was well tolerated, with only one patient developing Wieberdink grade IV toxicity (threatened/actual compartment syndrome) and none requiring amputation as a result of the procedure (grade V toxicity).
Minimally invasive ILI can effectively be used as palliative treatment to provide local tumor control and limb salvage in stage IV melanoma patients with advanced, symptomatic limb disease.
在晚期肢体黑色素瘤患者的治疗中，若同时存在远处转移，可能会出现一个主要的治疗难题。孤立肢体灌注（ILI）已被证明是一种有效的保肢治疗方法，对于美国癌症联合委员会（AJCC）IV期黑色素瘤患者可能具有姑息治疗价值。
我们确定了37例患有晚期症状性肢体疾病且在进行ILI时记录有远处转移的患者。所有患者均使用了美法仑和放线菌素D的联合药物。
51%的患者有内脏远处转移，49%的患者仅有皮肤远处转移。治疗肢体的总体缓解率为76%[完全缓解（CR）率22%，部分缓解（PR）率54%]。中位缓解持续时间为11个月（CR患者为28个月；p = 0.08）。CR后的中位生存期为22个月，PR后为17个月，病情稳定或进展的患者仅为4个月（p = 0.002）。与仅有皮肤远处转移的患者相比，有内脏远处转移的患者生存期显著缩短（分别为8个月和21个月；p = 0.03）。86%的患者实现了保肢。该手术耐受性良好，只有1例患者出现Wieberdink IV级毒性（有威胁/实际骨筋膜室综合征），且无患者因该手术需要截肢（V级毒性）。
微创ILI可有效用作姑息治疗，为患有晚期症状性肢体疾病的IV期黑色素瘤患者提供局部肿瘤控制和保肢。
