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01.11.2010 | Melanomas | Ausgabe 11/2010

Annals of Surgical Oncology 11/2010

Long-Term Results of Melphalan-Based Isolated Limb Perfusion With or Without Low-Dose TNF for In-Transit Melanoma Metastases

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 11/2010
Autoren:
MD Carlo Riccardo Rossi, MD Sandro Pasquali, MD, PhD Simone Mocellin, MD Antonella Vecchiato, MD Luca Giovanni Campana, MD Pierluigi Pilati, MD Antonio Zanon, MD Donato Nitti

Abstract

Background

The aims of the study were: (1) to determine toxicity, response rate, local-regional control, and survival in the entire population of the perfused patients; (2) to compare toxicity, response, and survival among patients who underwent melphalan-based perfusion with or without low-dose tumor necrosis factor (TNF); and (3) to identify factors that predict a complete response and survival.

Materials and Methods

A total of 53 patients with extensive in-transit metastases (47%) underwent perfusion with melphalan, and 59 (53%) also received low-dose TNF.

Results

No difference was observed between the 2 drug regimens for what concerns local toxicity (P = 1.0). The tumor complete response rate was higher in patients treated with TNF (60.3% versus 41.5%, P = .036), in particular in the case of locally advanced tumors (66.7% versus 30%, P = .049). The presence of lymph node metastases had a negative influence on the tumor response rate (P = .003). Median time to local progression and survival were 19.6 and 34.5 months, respectively. Long-term complete response was achieved in 68% of the patients with initial CR (39 of 57 patients). The tumor response after perfusion was the only prognostic factor for local control and survival (P < .0001 and P = .002, respectively).

Conclusions

In the case of locally advanced disease, the addition of low-dose TNF to melphalan-based isolated limb perfusion appears safe and particularly useful. The presence of lymph node metastases is associated with decreased response rates. A sustained complete response was obtained in about one-third of the patients.

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