EARLY ENDOTHELIUM ACTIVATION AND POLYMORPHONUCLEAR CELL INVASION PRECEDE SPECIFIC NECROSIS OF HUMAN-MELANOMA AND SARCOMA TREATED BY INTRAVASCULAR HIGH-DOSE TUMOR-NECROSIS-FACTOR-ALPHA (RTNF-ALPHA)

Twenty-seven patients treated with high-dose rTNF alpha, IFN gamma and melphalan by isolated limb perfusion were histologically documented. There were 20 cases of melanoma-in-transit metastases and 7 cases of h igh-grade soft-tissue sarcoma. Biopsies were taken before IFN gamma, a fter IFN gamma, before TNF alpha and between 2 hr and 60 days after th e TNF alpha perfusion. Immunohistochemistry was performed for adhesion molecules ICAM-I, ELAM-I (E selectin), VCAM-I and PECAM. During the f irst hours after beginning perfusion, the endothelial cells of the tum our capillaries appeared swollen. Significant tumour necrosis was alre ady observed 3 hours after the perfusion in melanoma cases. The overal l predominant feature was coagulative necrosis associated or not with haemorrhagic necrosis. TNF alpha induced increased expression of ELAM- I and VCAM-I adhesion molecules on intratumoral endothelial cells. The activated tumour vessels were progressively destroyed. Significant in travascular recruitment of polymorphonuclear cells (PMNs) was observed 3 hr after starting TNF alpha; it was followed by diapedesis and tumo ur colonization 3 days later. T lymphocytes and macrophages were detec ted during the first 7 days and B lymphocytes during the second week. Melanoma in transit metastases treated with alkylating agent alone did not show significant necrosis and did not express high levels of adhe sion molecules (ELAM-I,VCAM-I) nor infiltration by PMN. (C) 1994 Wiley -Liss, Inc.