Department of Surgical Oncology, Daniel den Hoed Cancer Centre, Erasmus MC, Rotterdam, The Netherlands.
Curr Opin Oncol. 2011 Mar;23(2):183-8. doi: 10.1097/CCO.0b013e3283424dbc.
The treatment of in-transit metastasis of melanoma remains challenging and is essentially dictated by the biological behavior of melanoma. When lesions are large or numerous, isolated limb perfusion (ILP) is an attractive treatment modality. In this review an overview of literature on treatment options of melanoma in-transit metastases will be discussed.
Most recent studies report on tumor necrosis factor (TNF) and melphalan based ILP (TM-ILP) series or mixed series of TM-ILP and melphalan only based ILP (M-ILP). After TM-ILP complete response rates of 70% (range 44-90%) have been reported, while for M-ILP this is lower with complete response rates of 54% (range 40-76%). The only randomized trial comparing TM-ILP and M-ILP revealed no clear benefit of TNF at 3 months, but improved outcome at 6 months and in patients with bulky disease. Reports on isolated limb infusion (ILI) with melphalan and actinimycin D indicate lower response rates, but similar local control rates as M-ILP at lower cost.
ILP is an attractive treatment option in melanoma patients with multiple in-transit metastases. In our opinion TM-ILP is superior to M-ILP as it achieves higher response rates, especially in patients with bulky disease. When lesions are small and in the distal two-thirds of the leg only, ILI is a valuable alternative.
黑色素瘤转移灶的治疗仍然具有挑战性，主要取决于黑色素瘤的生物学行为。当病变较大或较多时，隔离肢体灌注（ILP）是一种有吸引力的治疗方法。本文回顾了黑色素瘤转移灶治疗选择的文献。
最近的研究报告了肿瘤坏死因子（TNF）和甲氨蝶呤（TM-ILP）的 ILP 系列或 TM-ILP 和单独甲氨蝶呤（M-ILP）的混合系列。TM-ILP 后完全缓解率为 70%（范围为 44%-90%），而 M-ILP 的完全缓解率较低，为 54%（范围为 40%-76%）。唯一一项比较 TM-ILP 和 M-ILP 的随机试验显示，TNF 在 3 个月时没有明显获益，但在 6 个月时和 bulky 疾病患者中获益。单独使用甲氨蝶呤和放线菌素 D 的孤立肢体输注（ILI）的报告表明，反应率较低，但与 M-ILP 相比，局部控制率相似，成本更低。
ILP 是治疗黑色素瘤患者多发转移灶的一种有吸引力的选择。我们认为 TM-ILP 优于 M-ILP，因为它可以获得更高的反应率，尤其是在 bulky 疾病患者中。当病变较小且位于腿部远端的三分之二以下时，ILI 是一种有价值的替代方法。
