Karakousis C P, Kontzoglou K, Driscoll D L
State University of New York, Millard Fillmore Hospital, Buffalo 14209, USA.
Ann Surg Oncol. 1997 Sep;4(6):506-10. doi: 10.1007/BF02303677.
Perfusion remains the standard of regional chemotherapy for extremity in-transit lesions from melanoma. However, there is an interest in other forms of intraarterial chemotherapy due to the simplicity and feasibility of repeat administration of the latter.
Review of 51 patients with extremity in-transit lesions from melanoma treated with the tourniquet infusion (TI) method on the basis of a prospective protocol. Drugs used were either Adriamycin (group A) or Dacarbazine (DTIC) + cisDDP (group B). The median number of courses was two. Lesions were resected at the same time as TI (n = 27) or after a month or more of observation in the absence of complete regression.
There was no significant difference in response rates between groups A and B. The overall objective response rate in 24 evaluable patients was 75%, being complete in seven (29%), partial (> 50%) in 11 (46%), minor (< 50%) in three (12.5%), and progression of disease in three (12.5%). At a mean follow-up time of 40 months, no recurrence was observed in the treated extremity in 18 patients (35%), but further recurrences were noted in 31 patients (61%). The 5-year survival rate was 30%.
TI provides an objective response rate of 75% for in-transit lesions, but after TI and resection of in-transit lesions as needed, the recurrence rate in the treated extremity is high (61%). Further work is needed with higher drug doses, local hyperthermia, or the administration of suitable doses of new regimens that are more successful with perfusion.
灌注仍然是黑色素瘤肢体移行转移灶区域化疗的标准方法。然而，由于动脉内化疗的其他形式具有重复给药的简便性和可行性，人们对其产生了兴趣。
基于前瞻性方案对51例采用止血带灌注（TI）法治疗的黑色素瘤肢体移行转移灶患者进行回顾性研究。使用的药物为阿霉素（A组）或达卡巴嗪（DTIC）+顺铂（B组）。疗程中位数为两个。在进行TI的同时切除病灶（n = 27），或在观察一个月或更长时间后若病灶未完全消退则进行切除。
A组和B组的缓解率无显著差异。24例可评估患者的总体客观缓解率为75%，其中完全缓解7例（29%），部分缓解（> 50%）11例（46%），轻度缓解（< 50%）3例（12.5%），疾病进展3例（12.5%）。平均随访时间为40个月时，18例患者（35%）的治疗肢体未观察到复发，但31例患者（61%）出现了进一步复发。5年生存率为30%。
TI对移行转移灶的客观缓解率为75%，但在TI及根据需要切除移行转移灶后，治疗肢体的复发率较高（61%）。需要进一步研究采用更高药物剂量、局部热疗或给予更适合灌注且更有效的新方案合适剂量。
