REGIONAL CHEMOTHERAPY FOR MELANOMA - A 35-YEAR EXPERIENCE

Objective The authors present their 35-year experience with intra-arte rial chemotherapeutic regional perfusion of 1139 patients with melanom as, using an extracorporeal oxygenated circuit and heart-lung apparatu s. Summary Background Data Intra-arterial chemotherapy produces improv ed responses in many tumors. By isolating and sustaining the area with extracorporeal oxygenated circulation, high doses can be delivered to the tumor area, limited only by local toxicity. Drug levels up to 10 times those achieved by systemic administration are obtained. Methods Techniques for hyperthermic perfusion were developed for limbs, pelvis , head, neck, and skin of the breast. Melphalan (Burroughs Wellcome, R esearch Triangle Park, NC) was used in 753 patients. Combinations with melphalan or other drugs were used in remaining cases at temperature of 38 to 40 C for 30 to 60 minutes. Results Chemotherapy perfusion fol lowed by tumor excision or node dissection, was performed where indica ted. The cumulative 10-year survival for patients with localized melan omas was 70%. For patients with local recurrences or satellites within 3 cm, survival was 61%. For those with regionally confined intransit tumors, survival was 30%; for those with regional node involvement, 38 %; for those with intransit and nodal metastases, 16%; for those with distant metastases and perfusion-mainly to save functional limbs-survi val was 7%. Multiple perfusions were performed in 158 patients with re current disease on 366 occasions. Patients with indolent regionally co nfined melanomas were benefited by prolongation of useful life. Conclu sions Safe perfusion techniques are available for most anatomic region s. Increased chemotherapeutic doses are delivered to isolated areas li mited only by local toxicity. Adjunct perfusion in poor prognosis stag e I cases is useful in reducing local recurrence, and intransit or lym ph node metastases. Regional perfusion reduces the need for major ampu tation. Multiple perfusion can be useful in treating recurrent chronic melanoma.