In a nutshell
The authors discussed isolated limb perfusion, a procedure used to deliver high doses of drugs straight to the site of the tumor in patients with melanoma.
Some background
Melanoma is sensitive to chemotherapy but it needs higher doses of chemotherapy than other types of cancer. Isolated limb perfusion is a complex surgical procedure. It allows for high doses of chemotherapy (such as melphalan [Alkeran]) to be delivered directly into the leg or arm (limb) affected by cancer. During the procedure the patient’s limb is isolated from the blood circulation using a tight band. This helps protect patients’ organs from the high levels of chemotherapy.
Isolated limb perfusion with melphalan is an effective treatment for melanoma of arms and legs that cannot be removed by surgery. It is particularly useful for melanoma which has spread to the lymphatic vessels (vessels of the immune system).
Methods & findings
The authors examined previous studies and discussed the safety and effectiveness of isolated limb perfusion with melphalan.
One study assessed patients with locally advanced melanoma after the treatment. On average 54% of patients had complete disappearance of the visible tumors (complete response). About 25% of patients had disappearance of 50% of the total tumors. After 10 years 49% of patients who had a complete response were still alive. In another study 56% of patients older 75 years had complete response compared to 58% of younger patients.
If the melanoma relapses it is possible to repeat the procedure. In one study, 74% of patients had a complete response after repeated isolated limb perfusions. The cancer relapsed again after an average of 9 months.
Long-term complications were common after this treatment. These included frequent infections (3%), nerve problems (4%), pain (8%), muscle wasting or scarring (11%), limb malfunction (15%), and limb swelling (28%).
The bottom line
The authors concluded that isolated limb perfusion with melphalan is effective for patients with melanoma in their arms or legs.
The fine print
Isolated limb perfusion is a complex and highly skilled technique with a risk of severe side effects. This treatment is available only in specialized melanoma treatment centers.
Published By :
Surgical oncology
Date :
Jan 14, 2014
