Klop W M, Vrouenraets B C, van Geel B N, Eggermont A M, Klaase J M, Nieweg O E, Kroon B B
Department of Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek ziekenhuis), Amsterdam, The Netherlands.
J Am Coll Surg. 1996 Jun;182(6):467-72.
Melanoma recurring locoregionally after isolated limb perfusion (ILP) constitutes a therapeutic dilemma. Major amputation is a deterrent option for local control and palliation in these patients who have a rather poor prognosis. Little is known about the feasibility and efficacy of repeat ILP in these situations.
From 1978 to 1993, 28 patients with recurrent melanoma after ILP were retreated with various ILP procedures using melphalan. Eighteen patients underwent reperfusion by a single and four by a multiple normothermic schedule. Hyperthermia was applied in six repeat ILP procedures.
A complete remission was achieved in 14 (74 percent) of 19 patients with measurable disease, with a median limb recurrence-free interval of 11 months. A partial remission was obtained in one patient (5 percent). Two patients had no change of disease and two patients had progressive disease. In the remaining nine patients, all macroscopic tumor tissue was excised before or during the repeat ILP procedure. The median limb recurrence-free interval of these nine patients was 15 months. After a median follow-up period of 30 months after repeat ILP, seven (25 percent) of the 28 total patients were alive without disease. Acute regional tissue toxicity was more severe after repeat ILP than after the first procedure (p < 0.05). Long-term regional morbidity occurred in 11 percent of the patients.
A high complete remission rate can be obtained with repeat ILP using melphalan. However, the high limb recurrence rate and relatively short limb recurrence-free interval need improvement. Increased acute regional toxicity after repeat ILP can be explained by the use of more intensive schedules.
孤立肢体灌注（ILP）后局部区域复发的黑色素瘤构成了治疗难题。对于这些预后相当差的患者，大截肢是局部控制和缓解的一种有阻碍的选择。对于在这些情况下重复ILP的可行性和疗效知之甚少。
1978年至1993年，28例ILP后复发的黑色素瘤患者接受了使用美法仑的各种ILP程序再次治疗。18例患者采用单次常温灌注方案，4例采用多次常温灌注方案。6例重复ILP程序中应用了热疗。
19例可测量疾病患者中有14例（74%）实现完全缓解，肢体无复发生存期的中位数为11个月。1例患者（5%）获得部分缓解。2例患者疾病无变化，2例患者疾病进展。在其余9例患者中，所有宏观肿瘤组织在重复ILP程序之前或期间被切除。这9例患者肢体无复发生存期的中位数为15个月。重复ILP后中位随访30个月，28例患者中有7例（25%）无疾病存活。重复ILP后急性局部组织毒性比首次手术更严重（p<0.05）。11%的患者发生长期局部并发症。
使用美法仑重复ILP可获得较高的完全缓解率。然而，高肢体复发率和相对较短的肢体无复发生存期需要改善。重复ILP后急性局部毒性增加可通过使用更强化的方案来解释。
