Giới thiệu Một chi ảnh hưởng nặng nề bởi một tình trạng ung thư - trong-quá cảnh di căn khối u ác tính, địa phương lan rộng ung thư biểu mô da - là một tình huống lâm sàng kinh khủng, đôi khi dẫn đến cắt cụt chi giảm nhẹ. Ý tưởng đến Creech et al. | Melanoma Critical Debates Edited by Julia A. Newton Bishop Martin Gore Copyright 2002 Blackwell Science Ltd 17 Who should we consider for isolated limb perfusion Ferdy J. Lejeune and Danielle Liénard Introduction A limb heavily affected by a cancer condition in-transit melanoma metastases locally spreading skin carcinoma is an appalling clinical situation sometimes leading to palliative amputation. The idea came to Creech et al. from New Orleans 1 to isolate the affected limb and to connect it to a heart-lung machine in order to deliver a high concentration of cytostatics within a closed circuit while avoiding systemic toxicity Fig. . Besides nitrogen mustard which was the first drug melphalan or phenylalanine mustard PAM was quickly established as an effective agent in that setting although it was poorly effective when given systemically. Regional efficiency will depend upon the chosen drug and its concentration a concentration-dependent antitumour effect is a prerequisite. The lack of systemic toxicity will depend on the quality of surgical isolation the dissection of the vessels the ligation of the collateral vessels and efficacy and location of the tourniquet. In malignant melanoma the only indication for isolated limb perfusion ILP is in-transit metastasis confined to a limb in such an anatomical condition that surgical vascular isolation can be performed. In-transit melanoma metastasis High-risk primary melanoma mm of the limbs is prone to develop intransit metastasis within 5 years in 6-10 of cases 2 . These metastases are lymph-borne. They are the consequence of the penetration of the tumour cells into the dermal lymph channels followed by lymph flotation adhesion to endothelial cells extravasation and invasion of the adjacent tissues. The term in-transit is classically reserved for metastasis developing in the subcutis or in the skin between the primary and the regional lymph basin. The term satelli-tosis is assigned to dermo-epidermal metastases
