Results of cisplatin hyperthermic isolation perfusion for stage IIIA and IIIAB extremity melanoma

Between 1983 and 1992, 21 patients with extremity stage IIIA or IIIAB melanoma underwent hyperthermic isolation limb perfusion (HILP) with cisplatin in dosages varying from 26 to 237 mg/m2 as part of a pharmacokinetics and maximum-tolerated dose study. Extremity temperatures were up to 40 degrees C and the pH was controlled near 7.4. There were no major complications in this series of patients. Overall survival was 55% at 2 years and 47% at 5 years. Local control rates excluding regional nodal control was 79% at 2 years and 53% at 5 years. Local control, including regional nodal control, was 61% at 2 years and 36% at 5 years, indicating that cisplatin is not as effective at nodal control as it is at control of dermal or subcutaneous metastases. Three patients who failed cisplatin HILP have responded to re-perfusion with melphalan and actinomycin D. Two of the three patients had complete responses. It is concluded that cisplatin is an active agent against melanoma when employed by HILP. The drug is well tolerated at the doses and temperature employed, but it is not superior to HILP with melphalan.