TOURNIQUET INFUSION CHEMOTHERAPY FOR EXTREMITY IN-TRANSIT LESIONS IN MALIGNANT-MELANOMA

Background: Perfusion remains the standard of regional chemotherapy fo r extremity in-transit lesions from melanoma. However, there is an int erest in other forms of intraarterial chemotherapy due to the simplici ty and feasibility of repeat administration of the latter. Methods: Re view of 51 patients with extremity in-transit lesions from melanoma tr eated with the tourniquet infusion (TI) method on the basis of a prosp ective protocol. Drugs used were either Adriamycin (group A) or Dacarb azine (DTIC) + cisDDP (group B). The median number of courses was two. Lesions were resected at the same time as TI (n = 27) or after a mont h or more of observation in the absence of complete regression. Result s: There was no significant difference in response rates between group s A and B. The overall objective response rate in 24 evaluable patient s was 75%, being complete in seven (29%), partial (>50%) in 11 (46%), minor (<50%) in three (12.5%), and progression of disease in three (12 .5%). At a mean follow-up time of 40 months, no recurrence was observe d in the treated extremity in 18 patients (35%), but further recurrenc es were noted in 31 patients (61%). The 5-year survival rate was 30%. Conclusion: TI provides an objective response rate of 75% for in-trans it lesions, but after TI and resection of in-transit lesions as needed , the recurrence rate in the treated extremity is high (61%). Further work is needed with higher drug doses, local hyperthermia, or the admi nistration of suitable doses of new regimens that are more successful with perfusion.