LONG-TERM MORBIDITY AFTER REGIONAL ISOLATED PERFUSION WITH MELPHALAN FOR MELANOMA OF THE LIMBS - THE INFLUENCE OF ACUTE REGIONAL TOXIC REACTIONS

Objective: To determine the influence of acute regional toxic reaction s on the incidence and characteristics of long-term morbidity after re gional isolated perfusion with melphalan. Design: Retrospective study. Setting: The Amsterdam and Rotterdam perfusion centers, the Netherlan ds. Patients: All patients with melanoma who were treated between 1978 and 1990 and had a minimum follow-up of 1 year after perfusion (n=367 ). Intervention: Fifty-four patients (15%) had perfusion of the upper limb, 313 (85%) had perfusion of the lower limb, and 164 patients (45% ) underwent regional lymph node dissection at the time of perfusion. M ain Outcome Measure: Incidence and characteristics of morbidity 1 year after perfusion and the influence of acute regional toxic reactions o n long-term morbidity Results: One hundred sixty patients (44%) showed some degree of objective or subjective morbidity; most (104 [28%]) ha d lymphedema. Other long-term morbidity consisted of muscle atrophy or fibrosis (42 [11%]), limb malfunction (55 [15%]), neuropathy (13 [4%] ), pain (28 [8%]), and recurrent infection (11 [3%]). Miscellaneous co mplications were seen in 14 patients (4%). Seventy-one patients (19%) had more than one complication. Acute regional toxic reactions had a s tatistically significant effect on the incidence of long-term morbidit y (P<.01). Moderate to severe acute regional toxic reactions were stro ngly linked to the occurrence of muscle atrophy or fibrosis (P<.001) a nd limb malfunction (P<.001). Regional lymph node dissection was stati stically significantly related to lymphedema (P=.05). Conclusion: Impr ovement of the perfusion technique should be pursued in an effort to r educe acute regional toxic reactions, and thereby long-term morbidity, without compromising the therapeutic effect.