Papa M Z, Klein E, Karni T, Koller M, Davidson B, Azizi E, Ben-Ari G
Department of Surgical Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Am J Surg. 1996 Apr;171(4):416-20. doi: 10.1016/S0002-9610(97)89621-3.
The study was undertaken to review our experience in the treatment of extremity melanoma with hyperthermic isolated limb perfusion (HILP), using cisplatin as the chemotherapeutic agent. We also evaluated the best timing for regional lymph node dissection in relation to the perfusion.
Sixty patients with advanced malignant melanoma of the limbs were treated with HILP used mainly as an adjuvant treatment. There were 56 lower- and 4 upper-limb HILPs. Cisplatin was used at a dose of 20 mg/L of limb volume. Temperature at the tumor site was 39 degrees C to 40 degrees C. Postoperative complications, disease-free period, and time to recurrence were recorded.
There were no deaths related to the procedure. Forty-seven percent of the patients developed local complications; most complications were minor and resolved within 60 days. The local complication rate was higher when HILP was performed shortly after or simultaneously with regional lymph node dissection. None of the patients had systemic complications. Mean survival time from treatment was 87.2 months. Currently, 35 patients (58%) are alive and free of disease 52.7 +/- 22.5 months after HILP. Twelve patients (20%) are alive with recurrent disease, of which 5 recurred locally. The average time (+/- standard error of the mean) to recurrence was 24.5 +/- 13.8 months after perfusion.
HILP with cisplatin is a relatively safe procedure, which seems to increase locoregional control of advanced malignant melanoma of the extremity. Separating the timing of lymph node dissection from HILP by 6 to 8 weeks reduces the complication rate.
本研究旨在回顾我们使用顺铂作为化疗药物，通过高温离体肢体灌注（HILP）治疗肢体黑色素瘤的经验。我们还评估了与灌注相关的区域淋巴结清扫的最佳时机。
60例晚期肢体恶性黑色素瘤患者接受了主要作为辅助治疗的HILP。其中下肢HILP 56例，上肢HILP 4例。顺铂的使用剂量为每升肢体体积20毫克。肿瘤部位温度为39摄氏度至40摄氏度。记录术后并发症、无病生存期和复发时间。
无手术相关死亡病例。47%的患者出现局部并发症；大多数并发症较轻，60天内得以解决。在区域淋巴结清扫后不久或同时进行HILP时，局部并发症发生率较高。无患者出现全身并发症。治疗后的平均生存时间为87.2个月。目前，35例患者（58%）在HILP后52.7±22.5个月存活且无疾病。12例患者（20%）带复发疾病存活，其中5例为局部复发。灌注后复发的平均时间（±平均标准误差）为24.5±13.8个月。
顺铂HILP是一种相对安全的手术，似乎能增强对晚期肢体恶性黑色素瘤的局部区域控制。将淋巴结清扫时间与HILP间隔6至8周可降低并发症发生率。
