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首页> 外文期刊>Journal of the American College of Surgeons >Current trends in regional therapy for melanoma: lessons learned from 225 regional chemotherapy treatments between 1995 and 2010 at a single institution.
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Current trends in regional therapy for melanoma: lessons learned from 225 regional chemotherapy treatments between 1995 and 2010 at a single institution.

机译：黑色素瘤区域疗法的当前趋势：1995年至2010年间在一家机构中从225种区域化学疗法中汲取的经验教训。

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BACKGROUND: Hyperthermic isolated limb perfusion (HILP) and isolated limb infusion (ILI) are used to manage advanced extremity melanoma, but no consensus exists as to which treatment is preferable and how to monitor patients post-treatment. STUDY DESIGN: Using a prospectively maintained database, we reviewed our experience with melphalan-based HILP (which included 62 first-time and 10 second-time) and ILI (which included 126 first-time and 18 second-time) procedures performed in 188 patients. PET/CT was obtained 3 months postregional treatment for 1 year and then every 6 months thereafter. RESULTS: Overall response rate (complete response [CR] + partial response) of HILP was 81% (80% CI, 73-87%), and overall response rate from ILI was 43% (80% CI, 37-49%) for first-time procedures only. HILP had a CR rate of 55% with a median duration of 32 months, and ILI had a CR rate of 30% with median duration of 24 months. Patients who experienced a regional recurrence after initial regional treatment were more likely to achieve a CR after repeat HILP (50%, n = 10) compared with repeat ILI (28%, n = 18). Although the spectrum of toxicity was similar for ILI and HILP, the likelihood of rare catastrophic complication of limb loss was greater with HILP (2 of 62) than ILI (0 of 122). PET/CT was effective for surveillance after regional therapy to identify regional nodal and pulmonary disease that was not clinically evident, but often amenable to surgical resection (25 of 49; 51% of cases). In contrast, PET/CT was not effective at predicting complete response to treatment with an accuracy of only 50%. CONCLUSIONS: In the largest single-institution regional therapy series reported to date, we found that although ILI is effective and well-tolerated, HILP is a more definitive way to control advanced disease.
机译：背景：孤立的肢体灌注热疗（HILP）和孤立的肢体灌注（ILI）用于治疗晚期肢体黑色素瘤，但对于哪种治疗方法更好以及如何监测患者的治疗后尚无共识。研究设计：使用前瞻性维护的数据库，我们回顾了我们在188例中执行的基于美法仑的HILP（包括62例首次和10次第二次）和ILI（包括126例首次和18次第二次）程序的经验。耐心。进行区域治疗后3个月（一年），然后每6个月获得一次PET / CT。结果：HILP的总缓解率（完全缓解[CR] +部分缓解）为81％（80％CI，73-87％），而来自ILI的总体缓解率为43％（80％CI，37-49％）仅适用于首次程序。 HILP的CR率为55％，中位持续时间为32个月，ILI的CR率为30％，中位持续时间为24个月。与重复ILI（28％，n = 18）相比，在进行首次HILP后出现局部复发的患者更有可能在重复HILP（50％，n = 10）后获得CR。尽管ILI和HILP的毒性谱相似，但HILP（62分之2）比ILI（122分之0）发生肢体丢失的罕见灾难性并发症的可能性更大。 PET / CT可以在区域治疗后有效地进行监视，以识别临床上不明显但通常可进行手术切除的区域性淋巴结和肺部疾病（49例中有25例，占51％）。相反，PET / CT不能有效地预测对治疗的完全反应，其准确率仅为50％。结论：在迄今为止报道的最大的单机构区域治疗系列中，我们发现尽管ILI有效且耐受良好，但HILP是控制晚期疾病的更明确的方法。

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