IS THERE AN INDICATION FOR A DOUBLE PERFUSION SCHEDULE WITH MELPHALANFOR PATIENTS WITH RECURRENT MELANOMA OF THE LIMBS

It has been reported that a double perfusion schedule shows a better c omplete remission rate than does the single procedure for recurrent me lanoma of the limb. As more perfusion strategies approach the ideal of a 100% complete remission rate, the main issue now is to prolong the period of disease control in the limb, is to reduce the limb recurrenc e rate. The follow up of 42 patients treated with a double perfusion s chedule and of 45 patients treated with a single perfusion procedure w as updated to compare the duration of limb disease control. Both treat ment groups were well balanced with respect to patient and tumour char acteristics. For patients treated with a double schedule, the dose of melphalan given in the first perfusion was low (6 mg/l limb volume; 1 h; normothermic) in order to make ft possible to carry out a second pe rfusion (9 mg/l; 1 h; normothermic) with a planned short interval of 3 -4 weeks. In the single perfusion group a normothermic perfusion with 10 mg melphalan/l was carried out. The acute tissue reactions and long -term side effects did not differ between the two treatment modalities . The response rate was significantly higher in the double perfusion g roup owing to a higher complete remission rate (76% vs 48%; P= 0.006). However, no significant difference was seen in limb disease control r ates 3 years after perfusion (double schedule, 36%; single schedule, 3 0%), nor in overall 3-year survival (double schedule, 52%; single sche dule, 45%). When evaluating perfusion regimens with equally high compl ete remission rates, attention should be focused on the duration of li mb disease control.