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. 2012 Feb;19(2):627-35.
doi: 10.1245/s10434-011-2030-7. Epub 2011 Aug 31.

20 years experience of TNF-based isolated limb perfusion for in-transit melanoma metastases: TNF dose matters

Jan P Deroose  1 , Alexander M M Eggermont, Albertus N van Geel, Johannes H W de Wilt, Jacobus W A Burger, Cornelis Verhoef
Affiliations

20 years experience of TNF-based isolated limb perfusion for in-transit melanoma metastases: TNF dose matters

Jan P Deroose et al. Ann Surg Oncol. 2012 Feb.

Abstract

Background: Approximately 5-8% of melanoma patients will develop in-transit metastases (IT-mets). Tumor necrosis factor-α (TNF) and melphalan-based isolated limb perfusion (TM-ILP) is an attractive treatment modality in melanoma patients with multiple IT-mets. This study reports on a 20 years experience and outlines the evolution and major changes since the introduction of TNF in ILP.

Methods: A total of 167 TM-ILPs were performed in 148 patients, between 1991 and 2009. TM-ILPs were performed at high doses of TNF (3-4 mg) from 1991 to 2004 (n = 99) and at low doses of TNF (1-2 mg) from 2004 to 2009 (n = 68) under mild hyperthermic conditions (38°C-39.5°C.). Melphalan doses were unchanged at 10-13 mg/l (leg and arm, respectively). Characteristics for the 167 ILPs were: 81 stage IIIB, 65 stage IIIC, and 21 stage IV disease.

Results: The overall response rate was 89% (n = 148). (Complete response [CR] = 61%; partial response [PR] = 28%). CR rates correlated with stage (P = .001) and with high-dose vs. low-dose TNF (70% vs. 49%; P < .006). High-dose TNF prolonged local control (median 16 months vs. 11 months; P = .076). Survival was not influenced by TNF dose. CR after ILP and number of lesions also correlated with local progression-free interval. Overall survival did correlate with stage of disease (P < .001), size of the lesions (P = .001), and a CR (P < .001).

Conclusions: This 2-decade single-center experience demonstrates that TM-ILP is a safe and effective treatment modality for melanoma patients with multiple IT-mets. Higher dose of TNF was associated with significantly higher CR rates and prolonged local control without an effect on overall survival.

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Figures

Fig. 1
Fig. 1
Inclusion flow chart. TM-ILP TNF-based ILP, IT-Mets in-transit metastasis, LTFU lost through follow-up, POD perioperative death
Fig. 2
Fig. 2
a OS vs. complete response. b OS vs. AJCC stage of disease. c Recurrence-free interval vs. dose of TNF. d OS vs. dose of TNF. OS overall survival, CR complete response, PR partial response, NC no change, TNF tumor necrosis factor α, ILP isolated limb perfusion
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