Dossett Lesly A, Ben-Shabat Ilan, Olofsson Bagge Roger, Zager Jonathan S
Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center, Tampa, FL, USA.
Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
Ann Surg Oncol. 2016 Jul;23(7):2330-5. doi: 10.1245/s10434-016-5150-2. Epub 2016 Feb 29.
Isolated limb perfusion (ILP) and infusion (ILI) are therapeutic modalities for the treatment of in transit melanoma.
A retrospective review of all patients undergoing first-time ILI or ILP for in-transit melanoma metastases between 2007 and 2015 was performed. Demographic and clinical characteristics included age, sex, nodal status at the time of ILI/ILP (N-stage), and burden of disease (BOD). Regional toxicity was categorized by the Wieberdink classification. Clinical response was evaluated at 3 months after treatment.
A total of 203 patients were reviewed (ILI = 94, ILP = 109). There were no differences in age, sex, or N-stage between groups; however, BOD was higher for the ILI group (high BOD 58 vs. 44 %, p = 0.04). Regional toxicity was minimal (Grade IV < 1 % in ILI and 2 % in ILP, p = 0.40). Overall response rate (ORR) was 53 % for ILI versus 80 % for ILP (p < 0.001). Median overall survival (OS) was 46 months for ILI versus 40 months for ILP (p = 0.31). A high BOD [hazard ratio (HR) 3.02, 95 % confidence interval (CI) 1.85-4.93, p < 0.001] and N3 disease (HR 1.58, 95 % CI 1.01-2.48, p = 0.04) were associated with worse OS, whereas there was no difference in OS by procedure (p = 0.20).
ILP offers an improved ORR, but this does not translate into improved local PFS or OS. Both procedures are well tolerated with minimal regional toxicity.
孤立肢体灌注（ILP）和灌注（ILI）是治疗移行性黑素瘤的治疗方式。
对2007年至2015年间因移行性黑素瘤转移首次接受ILI或ILP治疗的所有患者进行回顾性研究。人口统计学和临床特征包括年龄、性别、ILI/ILP时的淋巴结状态（N分期）和疾病负担（BOD）。区域毒性根据Wieberdink分类进行分类。治疗后3个月评估临床反应。
共纳入203例患者（ILI = 94例，ILP = 109例）。两组间年龄、性别或N分期无差异；然而，ILI组的BOD更高（高BOD分别为58%和44%，p = 0.04）。区域毒性极小（ILI组IV级<1%，ILP组为2%，p = 0.40）。ILI的总缓解率（ORR）为53%，而ILP为80%（p < 0.001）。ILI的中位总生存期（OS）为46个月，ILP为40个月（p = 0.31）。高BOD [风险比（HR）3.02，95%置信区间（CI）1.85 - 4.93，p < 0.001]和N3期疾病（HR 1.58，95%CI 1.01 - 2.48，p = 0.04）与较差的OS相关，而不同治疗方法的OS无差异（p = 0.20）。
ILP可提高ORR，但这并未转化为局部无进展生存期（PFS）或OS的改善。两种治疗方法耐受性良好，区域毒性极小。
