TY - JOUR
T1 - Management of extremity recurrences after complete responses to isolated limb perfusion in patients with melanoma
AU - Feldman, Andrew L.
AU - Alexander, H. Richard
AU - Bartlett, David L.
AU - Fraker, Douglas L.
AU - Libutti, Steven K.
PY - 1999/9
Y1 - 1999/9
N2 - Background: Despite high rates of complete responses (CRs) to isolated limb perfusion (ILP) for patients with in-transit melanoma (60% to 90%), extremity recurrences are common. We evaluated our experience with managing these recurrences to determine how best to treat these patients. Methods: Between April 1992 and April 1998, 72 patients experienced CRs after hyperthermic ILP using Melphalan, with (n = 46) or without (n = 26) tumor necrosis factor. Of these, 25 patients (35%) experienced initial recurrences in the extremities, and they form the basis of this study. Results: Three patients who underwent repeat ILP for treatment of their recurrences experienced a second CR and recurrence in the extremity (at 9, 15, and 16 months), allowing analysis of 28 cases. For 5 of 20 recurrences managed with excision, 2 of 6 managed with repeat ILP, and 0 of 2 managed with systemic treatment, the patient was free of disease at the last follow-up examination (median follow-up period, 11 months). Conclusions: Isolated extremity recurrences after CRs to ILP occurred in 35% of patients. Initially, these could be managed successfully by excision or repeat ILP for the majority of patients (92%). We recommend excision of small-volume recurrent disease, reserving repeat ILP for patients with increasing numbers of lesions or increasing rapidity of in-field recurrences.
AB - Background: Despite high rates of complete responses (CRs) to isolated limb perfusion (ILP) for patients with in-transit melanoma (60% to 90%), extremity recurrences are common. We evaluated our experience with managing these recurrences to determine how best to treat these patients. Methods: Between April 1992 and April 1998, 72 patients experienced CRs after hyperthermic ILP using Melphalan, with (n = 46) or without (n = 26) tumor necrosis factor. Of these, 25 patients (35%) experienced initial recurrences in the extremities, and they form the basis of this study. Results: Three patients who underwent repeat ILP for treatment of their recurrences experienced a second CR and recurrence in the extremity (at 9, 15, and 16 months), allowing analysis of 28 cases. For 5 of 20 recurrences managed with excision, 2 of 6 managed with repeat ILP, and 0 of 2 managed with systemic treatment, the patient was free of disease at the last follow-up examination (median follow-up period, 11 months). Conclusions: Isolated extremity recurrences after CRs to ILP occurred in 35% of patients. Initially, these could be managed successfully by excision or repeat ILP for the majority of patients (92%). We recommend excision of small-volume recurrent disease, reserving repeat ILP for patients with increasing numbers of lesions or increasing rapidity of in-field recurrences.
KW - Complete response
KW - Limb perfusion
KW - Melanoma
KW - Melphalan
KW - Recurrence
UR - http://www.scopus.com/inward/record.url?scp=0032840437&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0032840437&partnerID=8YFLogxK
U2 - 10.1007/s10434-999-0562-x
DO - 10.1007/s10434-999-0562-x
M3 - Article
C2 - 10493624
AN - SCOPUS:0032840437
SN - 1068-9265
VL - 6
SP - 562
EP - 567
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 6
ER -