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January 1995

Long-term Morbidity After Regional Isolated Perfusion With Melphalan for Melanoma of the Limbs: The Influence of Acute Regional Toxic Reactions

Author Affiliations

From the Departments of Surgery, the Netherlands Cancer Institute (Antoni van Leeuwenhoek Huis), Amsterdam (Drs Vrouenraets, Klaase, and Kroon and Ms Franklin), and the Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands (Drs van Geel and Eggermont).

Arch Surg. 1995;130(1):43-47. doi:10.1001/archsurg.1995.01430010045009

Objective:  To determine the influence of acute regional toxic reactions on the incidence and characteristics of long-term morbidity after regional isolated perfusion with melphalan.

Design:  Retrospective study.

Setting:  The Amsterdam and Rotterdam perfusion centers, the Netherlands.

Patients:  All patients with melanoma who were treated between 1978 and 1990 and had a minimum follow-up of 1 year after perfusion (n=367).

Intervention:  Fifty-four patients (15%) had perfusion of the upper limb, 313 (85%) had perfusion of the lower limb, and 164 patients (45%) underwent regional lymph node dissection at the time of perfusion.

Main Outcome Measure:  Incidence and characteristics of morbidity 1 year after perfusion and the influence of acute regional toxic reactions on long-term morbidity.

Results:  One hundred sixty patients (44%) showed some degree of objective or subjective morbidity; most (104 [28%]) had lymphedema. Other long-term morbidity consisted of muscle atrophy or fibrosis (42 [11%]), limb malfunction (55 [15%]), neuropathy (13 [4%]), pain (28 [8%]), and recurrent infection (11 [3%]). Miscellaneous complications were seen in 14 patients (4%). Seventy-one patients (19%) had more than one complication. Acute regional toxic reactions had a statistically significant effect on the incidence of long-term morbidity (P<.01). Moderate to severe acute regional toxic reactions were strongly linked to the occurrence of muscle atrophy or fibrosis (P<.001) and limb malfunction (P<.001). Regional lymph node dissection was statistically significantly related to lymphedema (P=.05).

Conclusion:  Improvement of the perfusion technique should be pursued in an effort to reduce acute regional toxic reactions, and thereby long-term morbidity, without compromising the therapeutic effect.(Arch Surg. 1995;130:43-47)

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