One Hundred Consecutive Isolated Limb Perfusions With TNF-α and Melphalan in Melanoma Patients With Multiple In-Transit Metastases

In Brief Objective: The aim of this study is to describe the experience with 100 TNF-based ILP for locally advanced melanoma and to determine prognostic factors for response, time to local progression, and survival. Methods: One hundred TNF-based ILPs were performed between 1991 and 2003 in 87 patients for whom local control by surgery of in-transit melanoma metastases was impossible. In total, 62 iliac, 33 femoral, and 5 axillary ILPs were performed in mild hyperthermic conditions with 2 to 4 mg of TNF and 10 to 13 mg of melphalan per liter of limb volume. Results: Overall response was 95%, with 69% complete response, 26% partial response, and 5% no change. Complete response rate differed significantly for patients with IIIA disease versus IIIAB and IV. Local and systemic toxicity was mild to moderate in almost all cases, with no treatment-related death and one treatment-related amputation. Five-year overall survival was 32%; local progression occurred in 55% after a median of 16 months. In complete response patients, 5-year survival was 42% with local progression in 52% at a median of 22 months. Response rate and survival were significantly influenced by stage of disease; (local progression free) survival was influenced by response rate. Conclusions: TNF-based ILP results in excellent response rates in this patient population with unfavorable characteristics. Response on ILP predicts outcome in patients and reflects aggressiveness of the tumor. Isolated limb perfusions (ILP) have proven to be an effective regional treatment modality for in-transit metastasized melanoma. Tumor necrosis factor alpha (TNF) has lead to dramatic improvement of response rates, especially in patients with high tumor burden. One hundred TNF-based isolated limb perfusions for multiple in-transit melanoma metastases were performed in a single institution setting. Overall response was 95% with 69% CR rate. Stage of disease and CR were important indicators for survival and reflect the aggressiveness of the tumor.