Saida T
Dept. of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan.
Gan To Kagaku Ryoho. 1997 Jan;24(1):10-5.
Because malignant melanoma is a highly malignant neoplasm, correct diagnosis and appropriate treatment are essential to improve the prognosis. In the present paper the author summarizes the advancements in the therapy of malignant melanoma, reviewing papers recently published in this field. It is noteworthy that a narrow excision margin has been recommended even for the surgery of this neoplasm. This narrow margin has been approved by the prospective randomized trial performed by the WHO melanoma study group. The study group also confirmed that elective lymph node dissection is not significant in the improvement of the prognosis, when compared to the delayed lymph node dissection. Considering these findings, the author proposes a revised guideline for the treatment of malignant melanoma according to UICC stages. A brief comment is made on a new drug, fotemustine, that has an effect on brain metastases. In addition, high response rates obtained by the Dartmouth regimen (BCDT regimen), including tamoxifen, an estrogen antagonist, are reported. "Sequential" biochemoimmunotherapy based on a new concept of rational combination of chemotherapeutic and biologic agents seems highly effective against metastatic melanoma, showing more than 50% response rates. In the regimens, chemotherapy including CDDP is followed by administration of the cytokines, IL-2 and IFN-alpha. These regimens possibly induce specific and/or non-specific immune reactions against melanoma cells, which may contribute to the high response rates.
由于恶性黑色素瘤是一种高度恶性的肿瘤，正确诊断和恰当治疗对于改善预后至关重要。在本文中，作者总结了恶性黑色素瘤治疗方面的进展，并回顾了该领域最近发表的论文。值得注意的是，即使对于这种肿瘤的手术，也推荐采用窄切缘。这种窄切缘已得到世界卫生组织黑色素瘤研究组进行的前瞻性随机试验的认可。该研究组还证实，与延迟淋巴结清扫相比，选择性淋巴结清扫对改善预后并无显著作用。基于这些发现，作者根据国际抗癌联盟（UICC）分期提出了恶性黑色素瘤治疗的修订指南。对一种对脑转移有作用的新药福莫司汀作了简要评论。此外，还报道了包括雌激素拮抗剂他莫昔芬在内的达特茅斯方案（BCDT方案）取得的高缓解率。基于化疗药物与生物制剂合理联合的新概念的“序贯”生物化疗免疫疗法似乎对转移性黑色素瘤非常有效，缓解率超过50%。在这些方案中，包括顺铂的化疗之后给予细胞因子白细胞介素-2和干扰素-α。这些方案可能诱导针对黑色素瘤细胞的特异性和/或非特异性免疫反应，这可能是高缓解率的原因。
