Management of extremity recurrences after complete responses to isolated limb perfusion in patients with melanoma

Andrew L Feldman, H. Richard Alexander, David L. Bartlett, Douglas L. Fraker, Steven K. Libutti

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)562-567
Number of pages6
JournalAnnals of Surgical Oncology
Volume6
Issue number6
DOIs
StatePublished - 1999
Externally publishedYes

Fingerprint

Melanoma
Extremities
Perfusion
Recurrence
Melphalan
Tumor Necrosis Factor-alpha
Therapeutics

Keywords

  • Complete response
  • Limb perfusion
  • Melanoma
  • Melphalan
  • Recurrence

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Management of extremity recurrences after complete responses to isolated limb perfusion in patients with melanoma. / Feldman, Andrew L; Alexander, H. Richard; Bartlett, David L.; Fraker, Douglas L.; Libutti, Steven K.

In: Annals of Surgical Oncology, Vol. 6, No. 6, 1999, p. 562-567.

Research output: Contribution to journalArticle

Feldman, Andrew L ; Alexander, H. Richard ; Bartlett, David L. ; Fraker, Douglas L. ; Libutti, Steven K. / Management of extremity recurrences after complete responses to isolated limb perfusion in patients with melanoma. In: Annals of Surgical Oncology. 1999 ; Vol. 6, No. 6. pp. 562-567.
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abstract = "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.",
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