Long-term outcome of isolated limb perfusion with tumour necrosis factor-α for patients with melanoma in-transit metastases

Background: The use of tumour necrosis factor (TNF) alpha in isolated limb perfusion (ILP) for in-transit melanoma metastasis is not uniformly accepted. This article reports the long-term results of adding TNF-alpha to standard melphalan-based ILP (TM-ILP) for treatment of melanoma in-transit metastases. Methods: Data for patients treated between 1991 and 2005 were retrieved from a prospectively maintained database. Hyperthermic ILP was performed with 1-4 mg TNF-alpha. With a median potential follow-up of 13 years, response rates, time to local progression and disease-specific survival were analysed in relation to standard baseline factors. Results: Some 118 TM-ILPs were analysed in 105 patients, 54 for stage IIIA, 50 for stage IIIAB and 14 for stage IV disease. The overall response rate was 93.2 per cent; the response was complete in 67.8 per cent and partial in 25.4 per cent. The response rate was significantly influenced by stage of disease (IIIA versus IIIAB; P = 0.006). The complete response was maintained until the end of follow-up in 35 patients (33.3 per cent), and local control was achieved with one additional intervention in 12 others (11.4 per cent). Local progression occurred after 66 ILPs (55.9 per cent). Number of in-transit metastases (P = 0.008) and complete response after ILP (P < 0.001) were strong prognostic factors for time to local progression. The 5-year disease-specific survival rate was 27.3 per cent; survival was positively influenced by age, stage of disease, previous ILP and complete response after ILP. Conclusion: ILP with TNF-alpha may obtain long-term local control in selected patients with in-transit metastases from melanoma.