Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Aug 10, 2015; 6(4): 57-63
Published online Aug 10, 2015. doi: 10.5306/wjco.v6.i4.57
Isolated limb infusion chemotherapy with or without hemofiltration for recurrent limb melanoma
Sara Cecchini, Donatella Sarti, Stefano Ricci, Ludovico Delle Vergini, Manuela Sallei, Stefano Serresi, Giuseppe Ricotti, Luca Mulazzani, Fabrizia Lattanzio, Giammaria Fiorentini
Sara Cecchini, Stefano Ricci, Ludovico Delle Vergini, Manuela Sallei, Department of Vascular and Interventional Radiology, INRCA Hospital- IRCCS, 60127 Ancona, Italy
Donatella Sarti, Giammaria Fiorentini, Department of Oncology-Hematology, “Azienda Ospedaliera Ospedali Riuniti Marche Nord”, San Salvatore Hospital, 61122 Pesaro, Italy
Stefano Serresi, Giuseppe Ricotti, Unit of Dermatology, INRCA Hospital- IRCCS, 60127 Ancona, Italy
Luca Mulazzani, Department of Radiology, General Hospital “Azienda Ospedaliera Ospedali Riuniti Marche Nord”, 61122 Pesaro, Italy
Fabrizia Lattanzio, Italian National Research Center on Aging, Scientific Direction, 60127 Ancona, Italy
Author contributions: All authors contributed to this manuscript.
Institutional review board statement: The study was reviewed and approved by the Azienda Ospedaliera “Ospedali Riuniti Marche Nord” Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent before study enrollment.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Giammaria Fiorentini, Department of Oncology-Hematology, “Azienda Ospedaliera Ospedali Riuniti Marche Nord”, PO San Salvatore, via C. Lombroso 1, 61122 Pesaro, Italy.
Telephone: +39-721-364124 Fax: +39-721-364094
Received: December 19, 2014
Peer-review started: December 22, 2014
First decision: March 6, 2015
Revised: April 22, 2015
Accepted: June 15, 2015
Article in press: June 16, 2015
Published online: August 10, 2015

AIM: To better define the efficacy and the safety of intra-arterial infusion performed with or without hemofiltration for recurrent limb melanoma.

METHODS: Patients with the following characteristics were included in the study: recurrent limb melanoma not indicated for surgical resection, measurable disease in the extremity, > 18 years, performances status (Eastern Cooperative Oncology Group ) was 0-1 and life expectancy of at least 6 mo. Twenty nine consecutive patients were enrolled in the study. Patients underwent fluoroscopic placement of angiographic arterial and venous catheters to infuse the drug in the artery [isolated limb infusion (ILI)], and to stop the out flow (venous). Melphalan was rapidly infused into the isolated limb via the arterial catheter after the inflation of venous balloon catheter. Then the circulation of the limb was completely blocked with a pneumatic cuff at the root of the limb. Haemofiltration (HF) was available only in the main center, and was performed with an extracorporeal perfusion system, in order to reduce high systemic toxic peaks of drug.

RESULTS: Thirty seven ILI were done in 29 cases (31 ILI-HF and 6 ILI) between 2001 and 2014 at Ancona and Pesaro Hospitals, Italy. Clinical outcomes were monitored 30 d after treatment. Eleven patients (38%) received infusion of melphalan alone, 7 (24%) melphalan associated to mitomicin C and 7 (24%) melphalan associated to cisplatin, the remaining 4 were treated with cisplatin, melphalan and epirubicin or cisplatin and mitomicin C. The overall response rate was 66%, in particular, 3 patients (10%) were complete responders and 16 (56%) were partial responders; whereas 7 patients (24%) had stable disease, and 3 (10%) showed progressive disease. Limb toxicity was assessed adopting Wieberdink scale, with evidence of 90% of low grade (I and II) toxicity.

CONCLUSION: ILI-HF and ILI are effective and safe treatments for recurrent non-resectable limb melanoma. They present evidence of favorable clinical benefit and is effective in delaying progression.

Keywords: Metastatic melanoma, Melphalan, Intra-arterial infusion, Hemofiltration

Core tip: Isolated limb infusion (ILI) is a regional treatment of limb melanoma, allowing selective delivery of toxic agents to the arm or leg with the tumor, with limited leakage. Hemofiltration can reduce the high toxic peaks of drug in the blood, hence, limiting post-procedural side effects. In this paper we report results of an Italian Registry applying the ILI technique with or without Hemofiltration to recurrent non-resectable limb melanoma. The overall response rate was 66%. Low grade toxicity was observed in 90% of patients. ILI with/without hemofiltration is an efficacious and safe treatment for recurrent non-resectable limb melanoma.