BACKGROUND: In-transit metastases of Merkel cell carcinoma (MCC) are an unusual and therapeutically challenging manifestation of the disease. Given the similarity to melanoma, in-transit MCC may be amenable to isolated regional therapy. OBJECTIVE: To present a case series of 12 patients who underwent isolated limb perfusion (ILP) or isolated limb infusion (ILI) for in-transit MCC. METHODS: A literature search was conducted using Medline and Pubmed databases for MCC, ILP, and ILI as key words. Ten cases were identified and reviewed; two cases from our hospital were also included in the series. RESULTS: Nine patients underwent ILP, and three were treated with ILI. Eleven patients had a complete clinical response, and one had a partial response. All patients avoided limb amputation. Mean follow-up was 25.3 months. Mean duration of response was 21.8 months. Four patients relapsed regionally. Two patients developed distant metastases and died of their disease. CONCLUSION: This is the largest case series of in-transit MCC treated with ILP or ILI. Both techniques appear to be a low-morbidity alternative to amputation for the treatment of isolated extremity in-transit MCC. ILI is less invasive than ILP and may be a more practical first-line treatment option. The authors have indicated no significant interest with commercial supporters.
BACKGROUND: In-transit metastases of Merkel cell carcinoma (MCC) are an unusual and therapeutically challenging manifestation of the disease. Given the similarity to melanoma, in-transit MCC may be amenable to isolated regional therapy. OBJECTIVE: To present a case series of 12 patients who underwent isolated limb perfusion (ILP) or isolated limb infusion (ILI) for in-transit MCC. METHODS: A literature search was conducted using Medline and Pubmed databases for MCC, ILP, and ILI as key words. Ten cases were identified and reviewed; two cases from our hospital were also included in the series. RESULTS: Nine patients underwent ILP, and three were treated with ILI. Eleven patients had a complete clinical response, and one had a partial response. All patients avoided limb amputation. Mean follow-up was 25.3 months. Mean duration of response was 21.8 months. Four patients relapsed regionally. Two patients developed distant metastases and died of their disease. CONCLUSION: This is the largest case series of in-transit MCC treated with ILP or ILI. Both techniques appear to be a low-morbidity alternative to amputation for the treatment of isolated extremity in-transit MCC. ILI is less invasive than ILP and may be a more practical first-line treatment option. The authors have indicated no significant interest with commercial supporters.
Authors: Lilit Garibyan; Shane E Cotter; Jorgen L Hansen; Claire Noell; Andrew Dorosario; Desmond A O'Farrell; Phillip M Devlin; Linda C Wang Journal: Cancer J Date: 2013 Jul-Aug Impact factor: 3.360