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Ann Surg Oncol Early Release, published online ahead of print Jan 12 2004
Annals of Surgical Oncology, 10.1245/ASO.2004.03.019
 © 2004 Society of Surgical Oncology
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Original Articles

Hyperthermic Isolated Limb Perfusion With Low-Dose Tumor Necrosis Factor-{alpha} and Melphalan for Bulky In-Transit Melanoma Metastases

Carlo Riccardo Rossi, MD, Mirto Foletto, MD, Simone Mocellin, MD, Pierluigi Pilati, MD, Mario Lise, MD

From the Clinica Chirurgica Generale II, Dipartimento di Scienze Oncologiche e Chirurgiche, Università di Padova, Padova, Italy.

Address correspondence and reprint requests to: Carlo Riccardo Rossi, MD, Clinica Chirurgica Generale II, Dipartimento di Scienze Oncologiche e Chirurgiche, Università di Padova, Via Giustiniani, 2, 35128 Padova, Italy; Fax: 39-049-651891.


  Abstract

Background: Melphalan (L-PAM) hyperthermic isolated limb perfusion (HILP) is currently considered the standard treatment for patients with in-transit metastases from cutaneous melanoma. We here report on the results of L-PAM and low-dose tumor necrosis factor (TNF){alpha} HILP in patients with bulky disease.

Methods: Twenty patients underwent TNF{alpha} (1 mg) and L-PAM (10 mg/L) HILP. Perfusion was performed for 90 minutes, and systemic leakage was strictly monitored. Locoregional toxicity was evaluated according to Wieberdink’s criteria, whereas tumor response was evaluated with physical examination and ultrasound scan with or without fine-needle aspiration of any suspected recurrence.

Results: In all cases, systemic leakage was <5%. No postoperative deaths occurred, and locoregional toxicity was mild (grade 1 or 2) in 95% of patients. A complete tumor response was obtained in 14 patients (70%), and partial responses were obtained in 5 patients (25%). After a median follow-up of 18 months, six patients are alive and disease free, seven are alive with local or distant recurrence or both, and seven have died of disease.

Conclusions: Low-dose TNF{alpha} HILP can achieve tumor responses comparable with those reported with higher doses of cytokine. Moreover, this drug regimen is associated with acceptable local toxicity, carries a smaller risk of systemic toxicity, and incurs lower costs.

Key Words: Melanoma, Isolated limb perfusion, TNF{alpha}, Melphalan




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