› Forums › General Melanoma Community › Limb perfusion
- This topic has 21 replies, 5 voices, and was last updated 12 years ago by
Vermont_Donna.
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- August 23, 2013 at 2:52 pm
Here are two articles related to limb perfusion for melanoma:
Isolated limb perfusion for malignant melanoma
Hiram C Polk, Jr., M.D. and Michael J Edwards, M.D.
Department of Surgery University of Louisville School of Medicine, Louisville, Kentucky, U.S.A.Introduction
Isolated chemotherapeutic perfusion for extremity melanomas has experienced a resurgence of interest, marked by an increased number of reports showing significant therapeutic efficacy. The collective data regarding both synchronous and recurrent metastatic melanoma involving the regional skin and subcutaneous tissues (satellite and intransit metastases) is clear; these patterns of metastases are ideally treated with isolated hyperthermic chemotherapeutic perfusion (Taber and Polk 1997; Brobeil et al. 1998; Krementz et al. 1996). When feasible, perfusion in combination with surgical resection of identifiable disease is the best treatment approach for achieving local disease control and enhanced survival.
The value of perfusion for localized primary extremity melanoma is less well-defined and less widely accepted, but patients with poorer prognosis primary lesions are those most likely to benefit (Koops et al. 1998; Edwards et al. 1990).
Perhaps the data here will be helpful, though it is older. I think limb perfusion chemo is more commonly used for treatment of sarcoma in order to preserve the limb and prevent amputation. In fact, I think most facilities have the potential loss of a limb as part of the criteria for use. In other words, if treatment can be rendered that will preserve the limb….they use that first. However, if the option is only amputation…then limb perfusion is more commonly offered at that time. But, that may not always be the case. And it gets more hazy when melanoma is involved because it behaves so differently from other cancers. Some researchers have tried limb perfusion combined with removal of a melanoma lesion with the theory that they can rid the melanoma patient of any rogue melanoma cells that might be hanging around.
Hope this info helps. Wishing you the best.
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- August 23, 2013 at 3:40 pm
Just so you know, both of those articles were taken from a book on surgery that was published in 2001, so take the words "resurgence of interest" and "increased number of reports" with a grain of salt. To my mind, anything written about the treatment of melanoma prior to 2011 (i.e., before the advent of BRAF inhibitors and targeted immunotherapy) should be taken with a grain of salt. I'm not saying that these older techniques are useless. I'm only saying that the equations for weighing the risks and benefits for these older techniques changed markedly in recent years.
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- August 24, 2013 at 2:36 am
hi! i haven't been on this board for years! i had isolated limb perfusion at Mass General in 2005 i think. i have been NED since. Dr. Tanabe. My primary was very deep, I did 50 weeks of interferon and the melanoma recurred all over my leg. i have full use of my leg….let me know if i can answer anymore questions. it has been so long ago, that i have forgotten some of the particulars.
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- August 24, 2013 at 2:36 am
hi! i haven't been on this board for years! i had isolated limb perfusion at Mass General in 2005 i think. i have been NED since. Dr. Tanabe. My primary was very deep, I did 50 weeks of interferon and the melanoma recurred all over my leg. i have full use of my leg….let me know if i can answer anymore questions. it has been so long ago, that i have forgotten some of the particulars.
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- August 24, 2013 at 2:36 am
hi! i haven't been on this board for years! i had isolated limb perfusion at Mass General in 2005 i think. i have been NED since. Dr. Tanabe. My primary was very deep, I did 50 weeks of interferon and the melanoma recurred all over my leg. i have full use of my leg….let me know if i can answer anymore questions. it has been so long ago, that i have forgotten some of the particulars.
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- August 24, 2013 at 2:57 pm
The nwer treatments still have a lo w enough success rte that the older lower success rate treatments may be some peoplesonly chance for success. STILL want to knkow WHAT will WORK on WHO!
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- August 24, 2013 at 3:16 pm
That is great to hear, Dianne! After 10 years owith melanoma I have been in the watch and wait category and cutting edge treatment category having spent the past 2 3/4 years in a Phase I anti-PD1 trial. Sadly, Jerry, you are exactly right. I have been in a trial whose results for melanoma patients WITH disease had a greater than 30% response rate. However, "good" that may be…70% of the patients who take that drug in that category will gain NO benefit. While things are certainly improving….the fact that Jerry, Diane and I are all still here attests to that (or maybe just to our stubborness!!!)… we STILL need better treatments and have to recognize, that for many reasons, some treatments that provide even poorer results for most, may be a last chance for some. WIshing you all my very best. C
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- August 25, 2013 at 2:43 am
Hi,
I did an isolated limb perfusion at Mass General in 2009….and was NED for 11 months afterwards. I was facing right leg amputation due to many intransits…..I have written extensively on this board about my experience so like someone suggested if you put limb perfusion or isolated limb perfusion in the search bar you will get threads on the subject. I would be happy to talk further with you as well, if that would help…[email protected]….there is also the "isolated limb INFUSION" which you can research as well…….
Best of luck,
Vermont_Donna, stage 3a, NED (due to yervoy 2 1/2 years ago)
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- August 23, 2013 at 2:52 pm
Here are two articles related to limb perfusion for melanoma:
Isolated limb perfusion for malignant melanoma
Hiram C Polk, Jr., M.D. and Michael J Edwards, M.D.
Department of Surgery University of Louisville School of Medicine, Louisville, Kentucky, U.S.A.Introduction
Isolated chemotherapeutic perfusion for extremity melanomas has experienced a resurgence of interest, marked by an increased number of reports showing significant therapeutic efficacy. The collective data regarding both synchronous and recurrent metastatic melanoma involving the regional skin and subcutaneous tissues (satellite and intransit metastases) is clear; these patterns of metastases are ideally treated with isolated hyperthermic chemotherapeutic perfusion (Taber and Polk 1997; Brobeil et al. 1998; Krementz et al. 1996). When feasible, perfusion in combination with surgical resection of identifiable disease is the best treatment approach for achieving local disease control and enhanced survival.
The value of perfusion for localized primary extremity melanoma is less well-defined and less widely accepted, but patients with poorer prognosis primary lesions are those most likely to benefit (Koops et al. 1998; Edwards et al. 1990).
Perhaps the data here will be helpful, though it is older. I think limb perfusion chemo is more commonly used for treatment of sarcoma in order to preserve the limb and prevent amputation. In fact, I think most facilities have the potential loss of a limb as part of the criteria for use. In other words, if treatment can be rendered that will preserve the limb….they use that first. However, if the option is only amputation…then limb perfusion is more commonly offered at that time. But, that may not always be the case. And it gets more hazy when melanoma is involved because it behaves so differently from other cancers. Some researchers have tried limb perfusion combined with removal of a melanoma lesion with the theory that they can rid the melanoma patient of any rogue melanoma cells that might be hanging around.
Hope this info helps. Wishing you the best.
-
- August 23, 2013 at 2:52 pm
Here are two articles related to limb perfusion for melanoma:
Isolated limb perfusion for malignant melanoma
Hiram C Polk, Jr., M.D. and Michael J Edwards, M.D.
Department of Surgery University of Louisville School of Medicine, Louisville, Kentucky, U.S.A.Introduction
Isolated chemotherapeutic perfusion for extremity melanomas has experienced a resurgence of interest, marked by an increased number of reports showing significant therapeutic efficacy. The collective data regarding both synchronous and recurrent metastatic melanoma involving the regional skin and subcutaneous tissues (satellite and intransit metastases) is clear; these patterns of metastases are ideally treated with isolated hyperthermic chemotherapeutic perfusion (Taber and Polk 1997; Brobeil et al. 1998; Krementz et al. 1996). When feasible, perfusion in combination with surgical resection of identifiable disease is the best treatment approach for achieving local disease control and enhanced survival.
The value of perfusion for localized primary extremity melanoma is less well-defined and less widely accepted, but patients with poorer prognosis primary lesions are those most likely to benefit (Koops et al. 1998; Edwards et al. 1990).
Perhaps the data here will be helpful, though it is older. I think limb perfusion chemo is more commonly used for treatment of sarcoma in order to preserve the limb and prevent amputation. In fact, I think most facilities have the potential loss of a limb as part of the criteria for use. In other words, if treatment can be rendered that will preserve the limb….they use that first. However, if the option is only amputation…then limb perfusion is more commonly offered at that time. But, that may not always be the case. And it gets more hazy when melanoma is involved because it behaves so differently from other cancers. Some researchers have tried limb perfusion combined with removal of a melanoma lesion with the theory that they can rid the melanoma patient of any rogue melanoma cells that might be hanging around.
Hope this info helps. Wishing you the best.
-
- August 23, 2013 at 3:40 pm
Just so you know, both of those articles were taken from a book on surgery that was published in 2001, so take the words "resurgence of interest" and "increased number of reports" with a grain of salt. To my mind, anything written about the treatment of melanoma prior to 2011 (i.e., before the advent of BRAF inhibitors and targeted immunotherapy) should be taken with a grain of salt. I'm not saying that these older techniques are useless. I'm only saying that the equations for weighing the risks and benefits for these older techniques changed markedly in recent years.
-
- August 23, 2013 at 3:40 pm
Just so you know, both of those articles were taken from a book on surgery that was published in 2001, so take the words "resurgence of interest" and "increased number of reports" with a grain of salt. To my mind, anything written about the treatment of melanoma prior to 2011 (i.e., before the advent of BRAF inhibitors and targeted immunotherapy) should be taken with a grain of salt. I'm not saying that these older techniques are useless. I'm only saying that the equations for weighing the risks and benefits for these older techniques changed markedly in recent years.
-
- August 24, 2013 at 2:57 pm
The nwer treatments still have a lo w enough success rte that the older lower success rate treatments may be some peoplesonly chance for success. STILL want to knkow WHAT will WORK on WHO!
-
- August 24, 2013 at 2:57 pm
The nwer treatments still have a lo w enough success rte that the older lower success rate treatments may be some peoplesonly chance for success. STILL want to knkow WHAT will WORK on WHO!
-
- August 24, 2013 at 3:16 pm
That is great to hear, Dianne! After 10 years owith melanoma I have been in the watch and wait category and cutting edge treatment category having spent the past 2 3/4 years in a Phase I anti-PD1 trial. Sadly, Jerry, you are exactly right. I have been in a trial whose results for melanoma patients WITH disease had a greater than 30% response rate. However, "good" that may be…70% of the patients who take that drug in that category will gain NO benefit. While things are certainly improving….the fact that Jerry, Diane and I are all still here attests to that (or maybe just to our stubborness!!!)… we STILL need better treatments and have to recognize, that for many reasons, some treatments that provide even poorer results for most, may be a last chance for some. WIshing you all my very best. C
-
- August 24, 2013 at 3:16 pm
That is great to hear, Dianne! After 10 years owith melanoma I have been in the watch and wait category and cutting edge treatment category having spent the past 2 3/4 years in a Phase I anti-PD1 trial. Sadly, Jerry, you are exactly right. I have been in a trial whose results for melanoma patients WITH disease had a greater than 30% response rate. However, "good" that may be…70% of the patients who take that drug in that category will gain NO benefit. While things are certainly improving….the fact that Jerry, Diane and I are all still here attests to that (or maybe just to our stubborness!!!)… we STILL need better treatments and have to recognize, that for many reasons, some treatments that provide even poorer results for most, may be a last chance for some. WIshing you all my very best. C
-
- August 25, 2013 at 2:43 am
Hi,
I did an isolated limb perfusion at Mass General in 2009….and was NED for 11 months afterwards. I was facing right leg amputation due to many intransits…..I have written extensively on this board about my experience so like someone suggested if you put limb perfusion or isolated limb perfusion in the search bar you will get threads on the subject. I would be happy to talk further with you as well, if that would help…[email protected]….there is also the "isolated limb INFUSION" which you can research as well…….
Best of luck,
Vermont_Donna, stage 3a, NED (due to yervoy 2 1/2 years ago)
-
- August 25, 2013 at 2:43 am
Hi,
I did an isolated limb perfusion at Mass General in 2009….and was NED for 11 months afterwards. I was facing right leg amputation due to many intransits…..I have written extensively on this board about my experience so like someone suggested if you put limb perfusion or isolated limb perfusion in the search bar you will get threads on the subject. I would be happy to talk further with you as well, if that would help…[email protected]….there is also the "isolated limb INFUSION" which you can research as well…….
Best of luck,
Vermont_Donna, stage 3a, NED (due to yervoy 2 1/2 years ago)
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