Published online Aug 10, 2015. doi: 10.5306/wjco.v6.i4.57
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.
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.