One Hundred Consecutive Isolated Limb Perfusions with TNF-alpha and Melphalan in Melanoma Patients with Multiple In-transit Metastases

Overview

Journal Ann Surg

Specialty General Surgery

Date 2004 Dec 1

PMID 15570199

Citations 23

Authors

Dirk J Grunhagen

Flavia Brunstein

Wilfried J Graveland

Albertus N van Geel

Johannes H W de Wilt

Alexander M M Eggermont

Affiliations

Soon will be listed here.

Abstract

Objective: The aim of this study is to describe the experience with 100 TNF-based ILP for locally advanced melanoma and to determine prognostic factors for response, time to local progression, and survival.

Methods: One hundred TNF-based ILPs were performed between 1991 and 2003 in 87 patients for whom local control by surgery of in-transit melanoma metastases was impossible. In total, 62 iliac, 33 femoral, and 5 axillary ILPs were performed in mild hyperthermic conditions with 2 to 4 mg of TNF and 10 to 13 mg of melphalan per liter of limb volume.

Results: Overall response was 95%, with 69% complete response, 26% partial response, and 5% no change. Complete response rate differed significantly for patients with IIIA disease versus IIIAB and IV. Local and systemic toxicity was mild to moderate in almost all cases, with no treatment-related death and one treatment-related amputation. Five-year overall survival was 32%; local progression occurred in 55% after a median of 16 months. In complete response patients, 5-year survival was 42% with local progression in 52% at a median of 22 months. Response rate and survival were significantly influenced by stage of disease; (local progression free) survival was influenced by response rate.

Conclusions: TNF-based ILP results in excellent response rates in this patient population with unfavorable characteristics. Response on ILP predicts outcome in patients and reflects aggressiveness of the tumor.

Citing Articles

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Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature.

Sevilla-Ortega L, Ferrandiz-Pulido L, Palazon-Carrion N, Alamo de la Gala M, de Toro-Salas R, Garnacho-Montero J Cancers (Basel). 2021; 13(21).

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Comparative proteomics study of proteins involved in induction of higher rates of cell death in mitoxantrone-resistant breast cancer cells MCF-7/MX exposed to TNF-α.

Norouzi S, Yazdian Robati R, Ghandadi M, Abnous K, Behravan J, Mosaffa F Iran J Basic Med Sci. 2020; 23(5):663-672.

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Intra-arterial perfusion-based therapies for regionally metastatic cutaneous and uveal melanoma.

Broman K, Zager J Melanoma Manag. 2019; 6(3):MMT26.

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