Frequency and duration of remission after isolated limb perfusion for melanoma.

OBJECTIVE To examine the frequency and duration of complete remission for locally recurrent and metastatic limb melanoma after isolated limb perfusion (ILP) with cytotoxic agents. DESIGN A case series of 114 consecutive therapeutic ILPs performed between April 1984 and April 1994 and a review of previously published studies. SETTING A tertiary referral center for melanoma treatment, located at a university teaching hospital. RESULTS Of 111 assessable ILPs, 81 (73%) resulted in complete limb tumor remission and 14 (13%) resulted in partial remission (defined as a reduction in size of tumor deposits by > 50%). Complete remission was maintained in 37 (46%) of the 81 cases without any further treatment (median follow-up, 33 months; range, 8-112 months). Of the other 44 cases, disease subsequently recurred in the perfused limb (median time to recurrence, 9.5 months; range, 2-65 months). In 19 of these cases, however, the limb was again disease free at last follow-up after local surgery (12 cases) or a repeat ILP (7 cases). Overall, complete locoregional control was achieved after 50% of assessable ILPs, and a long-term disease-free state in the limb was achieved, with or without further treatment, in 56 (69%) of the 81 cases in which an initial complete remission occurred. For 743 therapeutic ILPs undertaken in 12 series previously reported in the literature, an initial complete remission was reported in 50% of these cases and partial remission in 32%. CONCLUSION Therapeutic ILP is an effective form of treatment for patients with recurrent and metastatic limb melanoma, achieving short- and long-term results that are superior to those achievable by any other form of treatment currently used.