CONVENTIONAL ISOLATED HYPERTHERMIC ANTIBLASTIC PERFUSION IN THE TREATMENT OF RECURRENT LIMB MELANOMA

Hypothermic Antiblastic Perfusion (HAP) is a widely used method for th e treatment of recurrent limb melanoma. In terms of tumor response, lo coregional control and survival HAP has led to better results than tho se achieved with any other treatment. The aim of this report is to ana lyze our own experience with HAP in locally advanced limb melanoma. Th irty-two patients were submitted to HAP. HAP lasted 60 minutes, with m aximal local temperature of 40.5 - 42 degrees C using melphalan 10 mg/ L limb volume as antiblastic agent. Twenty patients had in-transit met astases and 12 local recurrence. Regional nodes were involved in 12 pa tients. Systemic leakage monitored with I-125 or 99Tc ranged between 5 -30% (mean 14%). No operative mortality nor major complications occurr ed. Local toxicity scored Wieberdink grade I in 8 patients, grade II i n 17, grade III in 6 and grade IV in 1 case. Response rate (UICC) in t he 16 patients treated with unexcised lesions was 94% (56% complete re sponses). With a median follow-up of 29 months (2-126) 14 patients rel apsed after a median time of 10 months, and 17 patients are currently disease free, 3 of these are being re-excised and 3 re-perfused. Actua rial 5 years survival was 64% with 39% disease free to the first relap se. Our results are consistent with the literature indicating HAP as a safe procedure with a high evidence of clinical responses.