Treatment of In-Transit Metastases from Merkel Cell Carcinoma with Isolated Hyperthermic Limb Infusion/Reply

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Treatment of In-Transit Metastases from Merkel Cell Carcinoma with Isolated Hyperthermic Limb Infusion/Reply Powered By Docstoc
					Treatment of In-Transit Metastases from Merkel Cell Carcinoma with Isolated H...
Stephen R Grobmyer; Edward M Copeland III; Steven N Hochwald; Edward A Levine...
The American Surgeon; Dec 2008; 74, 12; Docstoc
pg. 122
				
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Description: In the management of in-transit melanoma, similar clinical results have been achieved with isolated limb perfusion and isolated limb infusion.5 Benefits associated with isolated limb infusion (compared with perfusion) are reduced operative times and complexity, reduced morbidity and resource use, and the ability to repeat the procedure as needed.4 Thompson et al. have also reported the use of isolated limb infusion for in-transit Merkel cell carcinoma.6 We feel, therefore, that isolated limb infusion represents a better, less invasive treatment option than isolated limb perfusion for patients with in-transit Merkel cell carcinoma and that isolated limb infusion should be considered in this subset of challenging patients. The insights of the University of Florida Surgery Oncology Group with regard to our letter regarding limb perfusion therapy for Merkel cell carcinoma with in-transit metastases are indeed timely and of interest.1 Although isolated hyperthermic limb perfusion (using a membrane oxygenator and perfusion pump) has been used for in-transit metastases for nearly 50 years, the availability of less invasive procedures is certainly an attractive and promising modality.2 Although the rarity of in-transit disease from Merkel cell carcinoma does not allow for a randomized trial to even be considered, extrapolation from the experience with melanoma makes limb infusion a very reasonable option in this setting.
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