Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.
Sahlgrenska Cancer Center, University of Gothenburg, 405 30, Gothenburg, Sweden.
Ann Surg Oncol. 2019 Apr;26(4):1055-1062. doi: 10.1245/s10434-018-07143-4. Epub 2019 Jan 7.
Isolated limb perfusion (ILP) is a safe and well-established treatment for in-transit metastases of melanoma. In case of relapse or disease progression, ILP can be repeated (re-ILP). This study aimed retrospectively to analyze a large consecutive series of re-ILP and compare clinical outcomes with first-time ILP.
Between 2001 and 2015, 290 consecutive patients underwent 380 ILPs. Of these, 90 were re-ILPs including 68 second ILPs, 16 third ILPs, 4 fourth ILPs, and two fifth ILPs. The study evaluated response (using World Health Organization [WHO] criteria), local toxicity (using the Wieberdink scale), and complications (using Clavien-Dindo).
The results were compared between the first ILP, the second ILP, and the third to fifth ILP. The overall response rate was respectively 83%, 80% and 68%, with a complete response (CR) rate of 60%, 41%, and 59%. In the re-ILP group, the patients with a CR after the first ILP had a 65% CR rate after the second ILP compared with 8% for the patients without a CR (p = 0.001). The risk for local toxicity or complications was not increased after re-ILP. The median overall survival periods were respectively 34, 41, and 93 months (p = 0.02).
As a therapeutic option, ILP can be repeated safely for in-transit metastases of melanoma, achieving similar high response rates without increasing complications or toxicity. Re-ILP is mainly indicated for patients who already had a CR after the first ILP, whereas other treatment options should be considered for primary non-responders.
孤立肢体灌注（ILP）是一种安全且成熟的治疗方法，适用于黑色素瘤的转移灶。在复发或疾病进展的情况下，可以重复进行 ILP（再 ILP）。本研究旨在回顾性分析一系列大型连续再 ILP 病例，并将其临床结果与首次 ILP 进行比较。
2001 年至 2015 年期间，290 例连续患者接受了 380 次 ILP。其中 90 例为再 ILP，包括 68 例第二次 ILP、16 例第三次 ILP、4 例第四次 ILP 和 2 例第五次 ILP。本研究评估了反应（采用世界卫生组织[WHO]标准）、局部毒性（采用 Wieberdink 量表）和并发症（采用 Clavien-Dindo 分类）。
将首次 ILP、第二次 ILP 和第三次至第五次 ILP 的结果进行比较。总体缓解率分别为 83%、80%和 68%，完全缓解（CR）率分别为 60%、41%和 59%。在再 ILP 组中，首次 ILP 后获得 CR 的患者，第二次 ILP 的 CR 率为 65%，而首次 ILP 后未获得 CR 的患者为 8%（p=0.001）。再 ILP 后局部毒性或并发症的风险并未增加。总生存中位数分别为 34、41 和 93 个月（p=0.02）。
作为一种治疗选择，ILP 可安全地重复用于黑色素瘤的转移灶，且不会增加并发症或毒性，仍可获得相似的高缓解率。再 ILP 主要适用于首次 ILP 后已获得 CR 的患者，而对于初次无应答者则应考虑其他治疗选择。
