Storm F K, Sparks F C, Morton D L
Surg Gynecol Obstet. 1979 Jul;149(1):17-21.
Twenty-seven patients with locally recurrent melanoma of the lower extremity were treated during a six year period. Recurrences were noted with primary lesions, at Clark's level II, III, IV or V, greater than 1.7 millimeters in depth of invasion and included intransit metastases, satellitosis, subcutaneous metastases and combinations of the three. Median time to recurrence was 12 to 14 months whether or not lymphadenectomy had been performed or lymph node metastases were present. Local recurrence was treated initially with intratumor bacille Calmette Guérin; 20 of 27 patients had complete or transient disease control and 14 patients were alive at 1.5 to 55.0 months. More responders reacted to dinitrochlorobenzene and purified protein derivative skin tests, although these parameters did not predict response to therapy. If intratumor bacille Calmette Guérin therapy did not control local disease or if the disease progressed toward the upper third of the thigh, patients underwent hyperthermic perfusion with L-phenylalanine mustard. Nine patients underwent ten therapeutic perfusions with objective response in seven of nine, with five being alive at two to 65 months. Intratumor bacille Calmette Guérin therapy and subsequent hyperthermic perfusion in bacille Calmette Guérin failures are rational treatment alternatives for locally recurrent melanomas of the extremity.
在六年期间，对27例下肢局部复发性黑色素瘤患者进行了治疗。复发见于原发性病变，处于克拉克分级II、III、IV或V级，浸润深度大于1.7毫米，包括皮肤转移、卫星灶、皮下转移以及三者的组合。无论是否进行了淋巴结清扫术或存在淋巴结转移，复发的中位时间为12至14个月。局部复发最初采用瘤内注射卡介苗治疗；27例患者中有20例疾病得到完全或暂时控制，14例患者在1.5至55.0个月时仍存活。更多的反应者对二硝基氯苯和纯化蛋白衍生物皮肤试验有反应，尽管这些参数不能预测对治疗的反应。如果瘤内注射卡介苗治疗不能控制局部疾病，或者疾病进展至大腿上三分之一处，患者则接受左旋苯丙氨酸氮芥热灌注治疗。9例患者接受了10次治疗性灌注，9例中有7例有客观反应，5例在2至65个月时仍存活。对于肢体局部复发性黑色素瘤，瘤内注射卡介苗治疗以及卡介苗治疗失败后的后续热灌注是合理的治疗选择。
