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Prophylactic isolation-perfusion as the primary therapy for invasive malignant melanoma of the limbs
Abstract:
The most common causes of treatment failure in patients with malignant melanoma treated by surgical therapy alone are local or regional recurrences. These are presumed to be due to occult metastasis present at the time of the initial treatment. In an effort to control this occult regional disease, 202 patients with Stage I malignant melanoma underwent isolation-perfusion with 1-phenylalanine mustard between the years 1960 and 1970. The 2-5 and 10-year determinate survival rates were 98%, 86% and 83%, respectively. In these patients, 2% developed local recurrences, 3% developed intransit metastasis, 18% developed positive regional lymph nodes and 6% developed disseminated disease, as their first evidence of recurrence. Over 40% of these patients were benefitted by further therapy. When regional perfusion is used, the question of prophylactic lymph node dissection need not arise. There was one surgical death in this series and only a few patients had symptomatology referable to their limbs beyond 3 months.
Insights
Isolation-perfusion with 1-phenylalanine mustard effectively treated occult regional disease in Stage I malignant melanoma patients. This surgical therapy showed promising survival rates and low recurrence rates, reducing the need for prophylactic lymph node dissection.
Area of Science:
- Surgical Oncology
- Medical Oncology
- Clinical Research
Background:
- Malignant melanoma treatment failure is often due to local or regional recurrences from occult metastases.
- Surgical therapy alone for malignant melanoma has limitations in controlling microscopic disease spread.
Purpose of the Study:
- To evaluate the efficacy of isolation-perfusion with 1-phenylalanine mustard in controlling occult regional disease in Stage I malignant melanoma.
- To assess the impact of this regional therapy on survival rates and recurrence patterns.
Main Methods:
- A cohort of 202 patients with Stage I malignant melanoma received isolation-perfusion with 1-phenylalanine mustard between 1960 and 1970.
- Follow-up data was analyzed to determine determinate survival rates and recurrence patterns.
Main Results:
- 2, 5, and 10-year determinate survival rates were 98%, 86%, and 83%, respectively.
- Recurrence rates included 2% local, 3% intransit metastasis, 18% positive regional lymph nodes, and 6% disseminated disease.
- Over 40% of patients benefited from subsequent therapies, and prophylactic lymph node dissection was deemed unnecessary.
Conclusions:
- Isolation-perfusion with 1-phenylalanine mustard is an effective method for managing occult regional disease in Stage I malignant melanoma.
- This approach offers significant survival benefits and a favorable safety profile, minimizing the need for extensive surgical procedures like lymph node dissection.