OBJECTIVE: The aim of this study is to describe the experience with 100
TNF-based ILP for locally advanced melanoma and to determine prognostic
factors for response, time to local progression, and survival. METHODS:
One hundred TNF-based ILPs were performed between 1991 and 2003 in 87
patients for whom local control by surgery of in-transit melanoma
metastases was impossible. In total, 62 iliac, 33 femoral, and 5 axillary
ILPs were performed in mild hyperthermic conditions with 2 to 4 mg of TNF
and 10 to 13 mg of melphalan per liter of limb volume. RESULTS: Overall
response was 95%, with 69% complete response, 26% partial response, and 5%
no change. Complete response rate differed significantly for patients with
IIIA disease versus IIIAB and IV. Local and systemic toxicity was mild to
moderate in almost all cases, with no treatment-related death and one
treatment-related amputation. Five-year overall survival was 32%; local
progression occurred in 55% after a median of 16 months. In complete
response patients, 5-year survival was 42% with local progression in 52%
at a median of 22 months. Response rate and survival were significantly
influenced by stage of disease; (local progression free) survival was
influenced by response rate. CONCLUSIONS: TNF-based ILP results in
excellent response rates in this patient population with unfavorable
characteristics. Response on ILP predicts outcome in patients and reflects
aggressiveness of the tumor