When malignant melanoma on an arm or leg advances it may become impossible to remove surgically, even if the cancer hasn’t spread to other areas of the body. In such cases, chemo delivered just to the affected limb offers a good treatment option, Dutch doctors report.

Their study shows that more than half of patients with locally unresectable melanoma achieve a complete response after so-called isolated limb perfusion with the chemo drug melphalan (abbreviated to M-ILP).

“Half of these patients are rendered disease-free for a long time,” Dr. Eva M. Noorda, at Slotervaart Hospital in Amsterdam, and her colleagues report in the Archives of Surgery for November.

Noorda’s team reviewed the outcomes of 108 patients with unresectable melanoma who underwent a total of 130 M-ILP treatments. The procedure involves clamping off circulation to the affected limb for an hour during which time perfusion is maintained using an external machine while the chemo is added to the oxygenated blood artificially circulating through the limb.

A complete response lasting an average of 10 months was attained in 72 (55 percent) of the 130 M-ILPs performed.

Whether the cancer had spread to lymph nodes was the only factor that affected the chances of a complete response and lack of recurrence in the affected limb. Otherwise, factors such as the site of the tumor, its thickness, or the number of tumors did not significantly affect outcomes.

After an average follow-up period of 21 months, only four patients required limb amputation, the researchers report.

Among patients who had a complete response, average survival was 44 months, compared with 15 months otherwise.

“Maximum efforts should be made to obtain a complete response,” Noorda’s group writes, “although the response to isolated limb perfusion is probably partly dictated by the biological features of the disease in the individual patient.”

SOURCE: Archives of Surgery, November 2004.