Gutman M, Abu-Abid S, Inbar M, Lev D, Chaitchik S, Sorkin P, Klausner J M
Department of Surgery B&C, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel.
Melanoma Res. 1996 Apr;6(2):167-71. doi: 10.1097/00008390-199604000-00012.
Loco-regional or pelvic metastases from malignant melanoma (MM) of the lower limbs or pelvis are usually refractory to systemic chemotherapy, the limiting factor being systemic toxicity. An attempt to improve this low response rate using a novel loco-regional approach involving intra-arterial high dose chemotherapy with concomitant hemofiltration of the venous effluent of the pelvis, hence chemofiltration, was studied. Chemofiltration was performed in seven MM patients. The arterial catheter and the venous cannula were placed in the aorta and the inferior vena cava just distal to the renal vessels. High-dose melphalan (1 mg/kg) or cis-platinum (200 mg/m2) was injected into the arterial catheter. Blood was pumped out into the hemofiltration unit at a rate of 500-700 ml/min. The filtered blood was returned via a catheter placed in the superior vena cava. Despite the extensive fluid exchange (9,700-15,000 ml), the procedure was well tolerated. Out of six patients who remained with measurable disease, three had a partial response lasting 5-12 months, two had stabilization of their disease for 3 months, and one developed a rapid progression. Chemofiltration is feasible in MM patients and is a viable option in locally advanced or metastatic malignant melanoma confined to the limb or pelvis.
下肢或骨盆恶性黑色素瘤（MM）的局部区域或盆腔转移通常对全身化疗耐药，限制因素是全身毒性。本研究尝试采用一种新的局部区域方法来提高这种低反应率，该方法包括动脉内高剂量化疗并同时对骨盆静脉流出液进行血液滤过，即化学滤过。对7例MM患者进行了化学滤过。动脉导管和静脉插管分别置于主动脉和肾血管远端的下腔静脉。将高剂量美法仑（1mg/kg）或顺铂（200mg/m²）注入动脉导管。血液以500 - 700ml/min的速度泵入血液滤过装置。滤过的血液通过置于上腔静脉的导管返回。尽管进行了大量的液体交换（9700 - 15000ml），但该操作耐受性良好。在6例仍有可测量病灶的患者中，3例出现部分缓解，持续5 - 12个月，2例病情稳定3个月，1例病情迅速进展。化学滤过在MM患者中是可行的，对于局限于肢体或骨盆的局部晚期或转移性恶性黑色素瘤是一种可行的选择。
