Isolated hyperthermic antiblastic perfusion in recurrent melanoma of the extremities

Twenty-two patients with recurrent melanoma of the limbs,underwent Hyperthermic Antiblastic Perfusion (HAP). HAP lasted 60 min,with maximal local temperature of 40.5-42 degrees C and melphalan 10 mg/L limb volume as antiblastic agent. Fourteen patients had in-transit metastases and 8 local recurrences. Regional nodes were involved in 6 patients. Systemic leakage monitored with 125I or 99Tc ranged between 5 and 30% (mean 19%). No operative mortality nor major complications occurred. Local toxicity scored Wieberdink grade I in 6 patients,grade II in 11 and III in 5. Response rate (UICC) in the 9 patients treated with unexcised lesions was 88% (55% complete responses). After a median follow-up of 27 months (1-92) 9 patients relapsed after a median time of 17 months,and 15 patients are currently disease free,4 of them being re-excised and one reperfused. Actuarial 5 year survival is 67%,with 45% disease free to the first relapse. Our results are consistent with the literature indicating HAP as a safe procedure with a high evidence of clinical responses