Tan E H, Ang P T
Department of Medical Oncology Singapore General Hospital, Singapore.
Singapore Med J. 1996 Apr;37(2):165-7.
Melanoma is rare in Singapore with an age-standardised rate (ASR) of 0.4-0.8 per 100,000 per year. Thirteen patients with metastatic or locally advanced melanoma were referred to the Department of Medical Oncology, Singapore General Hospital between Feb 1991 and Nov 1993. Ten patients were given combination chemotherapy comprising carmustine (BCNU), cisplatin, dacarbazine (DTIC) and tamoxifen. The remaining 3 patients either rejected chemotherapy or were too ill to receive chemotherapy. Patient characteristics were as follows: there were 6 males and 4 females; age range 29-75 years; all were Chinese; sites of primary disease: extremities 8, retroorbital 1, vagina 1; sites of metastases: lymph nodes 6, skin 2, pulmonary 3, liver 1. All received the same combination chemotherapy comprising iv BCNU 150 mg/m2 q8wk, iv DTIC 220 mg/m2 x 3 days q4 wk, iv cisplatin 25 mg/m2 x 3 days q4 wk and tab tamoxifen 40 mg daily. There were 6 partial responses and no complete responses, giving a response rate of 60% with a median survival of 11.5 months. Three patients with sites of disease in the vagina, retroorbital region and metastatic liver disease had progressive disease despite chemotherapy and one died of treatment related sepsis. The 6 responders include those with metastases to the skin, nodes and/or lung. Treatment was generally tolerable. Two patients experienced delays of their subsequent cycles of treatment by 1-2 weeks due either to neutropenia and/or thrombocytopenia. This regimen is a fairly active combination against metastatic melanoma, particularly those with metastases to the nodes, skin and the lung. Those with involvement of other sites tend to respond poorly.
黑色素瘤在新加坡较为罕见，年龄标准化发病率（ASR）为每年每10万人0.4 - 0.8例。1991年2月至1993年11月期间，13例转移性或局部晚期黑色素瘤患者被转诊至新加坡总医院肿瘤内科。10例患者接受了联合化疗，化疗方案包括卡莫司汀（BCNU）、顺铂、达卡巴嗪（DTIC）和他莫昔芬。其余3例患者要么拒绝化疗，要么病情太重无法接受化疗。患者特征如下：男性6例，女性4例；年龄范围为29 - 75岁；均为华裔；原发疾病部位：四肢8例，眶后1例，阴道1例；转移部位：淋巴结6例，皮肤2例，肺部3例，肝脏1例。所有患者均接受相同的联合化疗方案，即静脉注射BCNU 150 mg/m²，每8周一次；静脉注射DTIC 220 mg/m²，连续3天，每4周一次；静脉注射顺铂25 mg/m²，连续3天，每4周一次；口服他莫昔芬40 mg，每日一次。有6例部分缓解，无完全缓解，缓解率为60%，中位生存期为11.5个月。3例阴道、眶后区域和转移性肝病部位的患者尽管接受了化疗，但病情仍进展，1例死于治疗相关的败血症。6例缓解者包括皮肤、淋巴结和/或肺部转移的患者。治疗一般耐受性良好。2例患者因中性粒细胞减少和/或血小板减少导致后续治疗周期延迟1 - 2周。该方案对转移性黑色素瘤是一种相当有效的联合方案，特别是对那些有淋巴结、皮肤和肺部转移的患者。其他部位受累的患者往往反应较差。
