216 Isolated limb perfusion for stage IIIA-IIIAB melanoma: TNF + L-PAM and L-PAM + hyperthermia

The aim of this report is to compare two different approaches using ILP. Two series of patients with stage lIIA or IIIAB melanoma were treated by ILP at the National Cancer Institute, Milan. Forty-four patients (group 1) received α-tumor necrosis factor (α-TNF; 1–4 mg) plus melphalan (50–100 mg) and mild hyperthermia (39°C), while 133 patients (group 2) were treated using melphalan (50–100 mg) and hyperthermia (40.5°–41°). No significant differences were obtained in terms of both overall response rate (complete plus partial responses) in the two series of patients (70.4% in group I; 87.2% in group 2) and relapse rate (34.1% in group 1; 44.4% in group 2). A significant difference in the appearance of new relapses was observed (6 months for group 1; 13 months for group 2). After a median follow-up of II months in group 1,52.3% of patients have no evidence of disease, and 31.8% are alive with disease. In group 2 after a mean follow-up of 43 months, 30% of patients have no evidence of disease, and 8.3% are alive with disease. In conclusion, our experience did not confirm the impressive results demonstrated by other authors using α-TNF by ILP. This work has been supported by AIRC, contribution 1994.