Isolated Limb Perfusion in the Treatment of In-Transit Melanoma Metastases: Are There Predictive Factors for the Outcome?

Abstract

Introduction: Isolated limb perfusion (ILP) with delivery of high dose melphalan proved to be efficient in the treatment of in-transit metastases (ITM). Preoperative factors may carry an impact on patient outcome, including in-field or local progression-free survival (IPFS), time to distant metastases (TDM) and overall survival (OS). Materials and Methods: A retrospective analysis of 83 patients who underwent an ILP at our institution before the era of efficient upfront systemic therapy in high-risk cases. Patients were classified according to a modified M.D. Anderson score, with relevance for the outcome: 34 stage III A (patients with satellites and/or ITM), 31 stage III AB (patients with synchronous regional lymph node metastases and satellites and/or ITM), 11 at a new stage labelled III A(B) which takes into account a previous history of therapeutic regional node dissection and actual recurrence in the limb only, and 7 stage IV (metastatic cases with actual major problem of recurrence in the limb). Results: Our median follow-up time was 90.1 months (IQR 72.8-151.6). Median IPFS was 16.3 months (95% CI 9.5-78.5), median TDM 28.8 months (95% CI 15.4-69.6) and median OS 34.6 months (95% CI 21.1-59.5). The strongest significant prognostic factor regarding IPFS was LND before ILP (p=0.02). However, sex (p=0.03/0.07), LND before ILP (p=0.004/0.11) and some primary tumor characteristics (Clark level (p=0.15/0.07) and ulceration (p=0.006/0.04)) were prognostic regarding TDM and / or OS. Conclusion: ILP with melphalan can provide long-term regional and systemic tumor control in a selected group of patients and should be kept in mind for patients recurring after local surgery or radiotherapy and resistant to or ineligible for the newer systemic therapies.