PURPOSE OF REVIEW: The treatment of in-transit metastasis of melanoma remains challenging and is essentially dictated by the biological behavior of melanoma. When lesions are large or numerous, isolated limb perfusion (ILP) is an attractive treatment modality. In this review an overview of literature on treatment options of melanoma in-transit metastases will be discussed. RECENT FINDINGS: Most recent studies report on tumor necrosis factor (TNF) and melphalan based ILP (TM-ILP) series or mixed series of TM-ILP and melphalan only based ILP (M-ILP). After TM-ILP complete response rates of 70% (range 44-90%) have been reported, while for M-ILP this is lower with complete response rates of 54% (range 40-76%). The only randomized trial comparing TM-ILP and M-ILP revealed no clear benefit of TNF at 3 months, but improved outcome at 6 months and in patients with bulky disease. Reports on isolated limb infusion (ILI) with melphalan and actinimycin D indicate lower response rates, but similar local control rates as M-ILP at lower cost. SUMMARY: ILP is an attractive treatment option in melanoma patients with multiple in-transit metastases. In our opinion TM-ILP is superior to M-ILP as it achieves higher response rates, especially in patients with bulky disease. When lesions are small and in the distal two-thirds of the leg only, ILI is a valuable alternative.
PURPOSE OF REVIEW: The treatment of in-transit metastasis of melanoma remains challenging and is essentially dictated by the biological behavior of melanoma. When lesions are large or numerous, isolated limb perfusion (ILP) is an attractive treatment modality. In this review an overview of literature on treatment options of melanoma in-transit metastases will be discussed. RECENT FINDINGS: Most recent studies report on tumor necrosis factor (TNF) and melphalan based ILP (TM-ILP) series or mixed series of TM-ILP and melphalan only based ILP (M-ILP). After TM-ILP complete response rates of 70% (range 44-90%) have been reported, while for M-ILP this is lower with complete response rates of 54% (range 40-76%). The only randomized trial comparing TM-ILP and M-ILP revealed no clear benefit of TNF at 3 months, but improved outcome at 6 months and in patients with bulky disease. Reports on isolated limb infusion (ILI) with melphalan and actinimycin D indicate lower response rates, but similar local control rates as M-ILP at lower cost. SUMMARY: ILP is an attractive treatment option in melanomapatients with multiple in-transit metastases. In our opinion TM-ILP is superior to M-ILP as it achieves higher response rates, especially in patients with bulky disease. When lesions are small and in the distal two-thirds of the leg only, ILI is a valuable alternative.
Authors: Dennis Kobelt; Jutta Aumann; Manuel Schmidt; Burghardt Wittig; Iduna Fichtner; Diana Behrens; Margit Lemm; Greta Freundt; Peter M Schlag; Wolfgang Walther Journal: Mol Oncol Date: 2014-01-18 Impact factor: 6.603
Authors: Ravi P Sahu; Jesus A Ocana; Kathleen A Harrison; Matheus Ferracini; Christopher E Touloukian; Mohammed Al-Hassani; Louis Sun; Mathew Loesch; Robert C Murphy; Sandra K Althouse; Susan M Perkins; Paul J Speicher; Douglas S Tyler; Raymond L Konger; Jeffrey B Travers Journal: Cancer Res Date: 2014-10-10 Impact factor: 12.701
Authors: Lars Erik Podleska; Thorsten Poeppel; Michael Herbrik; Lisa Dahlkamp; Florian Grabellus; Georg Taeger Journal: World J Surg Oncol Date: 2014-04-01 Impact factor: 2.754