Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
Department of Cutaneous Oncology, Moffitt Cancer Center, 10920 McKinley Dr., MKC 4123, Tampa, FL, 33612, USA.
Clin Exp Metastasis. 2018 Aug;35(5-6):495-502. doi: 10.1007/s10585-018-9890-1. Epub 2018 May 8.
Locoregionally advanced and unresectable disease can be seen in up to 10% of melanoma patients. Treatment options for these patients have been evolving most notably over the past few decades and have demonstrated efficacy through multiple intra-arterial as well as intralesional therapies. Isolated limb perfusions and isolated limb infusions have been utilized to treat locoregionally advanced melanoma of the extremity with overall response rates up to 90% in some reports. Intralesional therapies, for in transit metastatic melanoma, such as Bacille Calmette-Guerin, talimogene laherparepvec, and PV-10 (Rose Bengal) have all demonstrated efficacy in the treatment of unresectable cutaneous melanoma. The treatment effect due to intralesional injection has been identified in directly injected lesions as well as in distant uninjected "bystander lesions" with some injectables. This bystander effect is likely an immunologic reaction due to tumor antigen release, antigen-presenting cell uptake, T cell activation and subsequent bystander tumor destruction in uninjected lesions. Treatment options for unresectable melanoma metastases limited to the liver include isolated hepatic perfusion, which can now be performed through a minimally invasive approach known as percutaneous hepatic perfusion. These intra-arterial and intralesional regional therapies offer a variety of effective treatment modalities for unresectable disease and may potentially be combined with systemic treatments, such as immunotherapy, in the future treatment of locoregionally advanced melanoma.
局部晚期和不可切除的疾病在多达 10%的黑色素瘤患者中可见。这些患者的治疗选择一直在演变，尤其是在过去几十年中，通过多种动脉内和瘤内治疗已经证明了其疗效。孤立肢体灌注和孤立肢体输注已被用于治疗肢体局部晚期黑色素瘤，在一些报道中总体反应率高达 90%。对于转移性黑色素瘤，如卡介苗、替莫唑胺、PV-10（孟加拉玫瑰红）等瘤内治疗，已被证明在治疗不可切除的皮肤黑色素瘤方面有效。由于瘤内注射，直接注射的病变以及未注射的“旁观者病变”都显示出了治疗效果，一些注射剂也有这种效果。这种旁观者效应可能是由于肿瘤抗原释放、抗原呈递细胞摄取、T 细胞激活以及随后未注射病变中的旁观者肿瘤破坏引起的免疫反应。对于仅限于肝脏的不可切除黑色素瘤转移，治疗选择包括孤立性肝灌注，现在可以通过一种称为经皮肝灌注的微创方法来进行。这些动脉内和瘤内区域性治疗为不可切除疾病提供了多种有效的治疗方式，并可能在未来局部晚期黑色素瘤的治疗中与全身治疗（如免疫疗法）联合应用。
