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Regional hyperthermic perfusion with melphalan after surgery for recurrent malignant melanoma of the extremities - Long-term follow-up of a randomised trial

Journal article
Authors Roger Olofsson Bagge
Jan Mattsson
Lars-Olof Hafström
Published in International Journal of Hyperthermia
Volume 30
Issue 5
Pages 295-298
ISSN 0265-6736
Publication year 2014
Published at Institute of Clinical Sciences, Department of Surgery
Pages 295-298
Language en
Links dx.doi.org/10.3109/02656736.2014.93...
Keywords Isolated limb perfusion, Adjuvant treatment, Melanoma, Randomized trial, ISOLATED LIMB PERFUSION, IN-TRANSIT METASTASES, CHEMOTHERAPY, Oncology, Radiology, Nuclear Medicine & Medical Imaging
Subject categories Cancer and Oncology

Abstract

Introduction: Isolated limb perfusion (ILP) is a treatment option most commonly used in the treatment of melanoma in-transit metastases of the extremities. The principle idea is to surgically isolate a region of the body and then deliver a high concentration of a chemotherapeutic agent together with hyperthermia. There have been three randomised trials exploring whether adjuvant ILP to patients with recurrent or high-risk primary melanomas increases survival; one of these trials has now been updated with a 25-year follow-up. Methods: The original study randomised 69 patients (between 1981 and 1989) with their first satellite or in-transit recurrence to either wide excision (WE group, n=36 patients) or to WE and adjuvant ILP (WE + ILP group, n=33 patients). Follow-up data 25 years later concerning survival and cause of death was retrieved from the Swedish National Cause of Death Register. Results: In the WE + ILP group there were 20 deaths (61%) due to melanoma compared with 26 deaths (72%) in the WE group (p=0.31). Median melanoma-specific survival was 95 months for WE + ILP compared to 38 months for the WE group, an almost 5 year benefit without statistical significance (p=0.24). Discussion: There is no evidence that adjuvant ILP prolongs survival in patients with high-risk or recurrent melanoma; however, the existing randomised trials are largely underpowered to detect such a difference. New studies are exploring systemic immunological effects of ILP, and a combination of regional therapy and immunotherapy may serve as a rationale for new trials using ILP in the future.

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