BACKGROUND: Isolated limb perfusion (ILP) involves the administration of chemotherapy drugs directly into a limb involved by locoregional metastases. Unresectable locally advanced melanoma of the limbs represents one of the clinical settings in which ILP has demonstrated benefits. METHODS: A systematic review of the literature on ILP for patients with unresectable locally advanced melanoma of the limbs was conducted. MEDLINE, EMBASE, and Cochrane database searches were conducted to identify studies fulfilling the following inclusion criteria: hyper- or normothermic ILP with melphalan with or without tumor necrosis factor (TNF) or other drugs providing valid data on clinical response, survival, or toxicity. To allocate levels of evidence and grades of recommendation the Scottish Intercollegiate Guidelines Network system was used. RESULTS: Twenty-two studies including 2,018 ILPs were selected with a clear predominance of observational studies (90.90%) against experimental studies (9.10%). The median complete response rate to ILP was of 58.20%, with a median overall response rate of 90.35%. ILP with melphalan yielded a median complete response rate of 46.50%, against a 68.90% median complete response rate for melphalan plus TNF ILP. The median 5-year overall-survival rate was 36.50%, with a median overall survival interval of 36.70 months. The Wieberdink IV and V regional toxicity rates were 2.00% and 0.65%, respectively. CONCLUSIONS: ILP is effective in achieving clinical responses in patients with unresectable locally advanced melanoma of the limbs. The disease-free and overall survival rates provided by ILP are acceptable. ILP is safe, with a low incidence of severe regional and systemic toxicity.
BACKGROUND: Isolated limb perfusion (ILP) involves the administration of chemotherapy drugs directly into a limb involved by locoregional metastases. Unresectable locally advanced melanoma of the limbs represents one of the clinical settings in which ILP has demonstrated benefits. METHODS: A systematic review of the literature on ILP for patients with unresectable locally advanced melanoma of the limbs was conducted. MEDLINE, EMBASE, and Cochrane database searches were conducted to identify studies fulfilling the following inclusion criteria: hyper- or normothermic ILP with melphalan with or without tumor necrosis factor (TNF) or other drugs providing valid data on clinical response, survival, or toxicity. To allocate levels of evidence and grades of recommendation the Scottish Intercollegiate Guidelines Network system was used. RESULTS: Twenty-two studies including 2,018 ILPs were selected with a clear predominance of observational studies (90.90%) against experimental studies (9.10%). The median complete response rate to ILP was of 58.20%, with a median overall response rate of 90.35%. ILP with melphalan yielded a median complete response rate of 46.50%, against a 68.90% median complete response rate for melphalan plus TNF ILP. The median 5-year overall-survival rate was 36.50%, with a median overall survival interval of 36.70 months. The Wieberdink IV and V regional toxicity rates were 2.00% and 0.65%, respectively. CONCLUSIONS: ILP is effective in achieving clinical responses in patients with unresectable locally advanced melanoma of the limbs. The disease-free and overall survival rates provided by ILP are acceptable. ILP is safe, with a low incidence of severe regional and systemic toxicity.
Authors: E M Noorda; B C Vrouenraets; O E Nieweg; A N van Geel; A M M Eggermont; B B R Kroon Journal: Ann Surg Oncol Date: 2002-12 Impact factor: 5.344
Authors: D Liénard; A M Eggermont; H S Koops; B Kroon; G Towse; S Hiemstra; P Schmitz; J Clarke; G Steinmann; F Rosenkaimer; F J Lejeune Journal: Melanoma Res Date: 1999-10 Impact factor: 3.599
Authors: B C Vrouenraets; A M Eggermont; A A Hart; J M Klaase; A N van Geel; O E Nieweg; B B Kroon Journal: Eur J Surg Oncol Date: 2001-06 Impact factor: 4.424
Authors: C M Balch; A C Buzaid; S J Soong; M B Atkins; N Cascinelli; D G Coit; I D Fleming; J E Gershenwald; A Houghton; J M Kirkwood; K M McMasters; M F Mihm; D L Morton; D S Reintgen; M I Ross; A Sober; J A Thompson; J F Thompson Journal: J Clin Oncol Date: 2001-08-15 Impact factor: 44.544
Authors: C Hoeller; B Jansen; E Heere-Ress; T Pustelnik; U Mossbacher; H Schlagbauer-Wadl; K Wolff; H Pehamberger Journal: J Invest Dermatol Date: 2001-08 Impact factor: 8.551
Authors: T G Zogakis; D L Bartlett; S K Libutti; D J Liewehr; S M Steinberg; D L Fraker; H R Alexander Journal: Ann Surg Oncol Date: 2001-12 Impact factor: 5.344
Authors: Boudewijn van Etten; Albertus N van Geel; Johannes H W de Wilt; Alexander M M Eggermont Journal: Ann Surg Oncol Date: 2003 Jan-Feb Impact factor: 5.344
Authors: Carlo Riccardo Rossi; Francesco Russano; Simone Mocellin; Vanna Chiarion-Sileni; Mirto Foletto; Pierluigi Pilati; Luca G Campana; Antonio Zanon; Gian Franco Picchi; Mario Lise; Donato Nitti Journal: Ann Surg Oncol Date: 2008-02-05 Impact factor: 5.344
Authors: T J Quinn; N Healy; A Sara; E Maggi; C S Claros; R Kabarriti; L Scandiuzzi; L Liu; J Gorecka; A Adem; I Basu; Z Yuan; C Guha Journal: Cancer Gene Ther Date: 2016-12-09 Impact factor: 5.987
Authors: Ton Wang; Nicholas Osborne; John Rechtenwald; Alex Kim; Niki Matusko; Rita Mayle; Mark S Cohen Journal: Am J Surg Date: 2019-10-05 Impact factor: 2.565