Isolated Limb Perfusion for Malignant Melanoma: Systematic Review on Effectiveness and Safety

• Published in: The oncologist (Dayton, Ohio) Vol. 15; no. 4; pp. 416 - 427
• Main Authors: Moreno‐Ramirez, David, Cruz‐Merino, Luis, Ferrandiz, Lara, Villegas‐Portero, Roman, Nieto‐Garcia, Adoracion
• Format: Journal Article
• Language: English
• Published: Durham, NC, USA AlphaMed Press 01-04-2010
• Subjects: Antineoplastic Agents, Alkylating - administration & dosage; Antineoplastic Agents, Alkylating - therapeutic use; Chemotherapy; Chemotherapy, Cancer, Regional Perfusion - adverse effects; Chemotherapy, Cancer, Regional Perfusion - methods; Chemotherapy, Cancer, Regional Perfusion - statistics & numerical data; Disease Progression; Extremities; Humans; Isolated limb perfusion; Malignant melanoma; Melanoma - drug therapy; Melanoma - mortality; Melanoma - pathology; Melanoma and Cutaneous Malignancies; Melphalan; Melphalan - administration & dosage; Melphalan - therapeutic use; Spain; Treatment Outcome; Tumor necrosis factor; Spain
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2009-0325

Learning Objectives
After completing this course, the reader will be able to:
Compare the response rate of ILP with melphalan and TNF to the response rate of ILP with single‐agent melphalan in patients with unresectable locally advanced melanoma of the limbs.
Compare the clinical response rates of repeated ILP after a recurrence or PR to a first ILP to clinical response rates after first ILP in patients with unresectable locally advanced melanoma of the limbs.
In patients with unresectable malignant melanoma of the limbs, consider use of ILP to avoid amputation.
This article is available for continuing medical education credit at CME.TheOncologist.com
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.
The present study describes the results of a systematic review conducted to objectively assess the clinical effectiveness and toxicity of isolated limb perfusion for the treatment of patients with locally advanced melanoma of the limbs. The technique was found to be safe and efficacious in these patients.