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Biomedical subjects

H Martijn

Publications and source records attributed to H Martijn.

23 records · Page 2Linked to original sources
PubMed1986

Comparison of two methods of treating primary malignant melanomas Clark IV and V, thickness 1.5 mm and greater, localized on the extremities. Wide surgical excision with and without adjuvant regional perfusion.

A comparative retrospective study of patients with primary malignant melanomas of the extremities, Clark level IV/V and tumor thickness greater than or equal to 1.5 mm, was performed in Sydney (Australia) and Groningen (The Netherlands). The efficacy of wide local excision combined with adjuvant regional perfusion (Groningen) was compared with that of wide surgical excision only (Sydney). Patients were classified by sex and tumor location. There were only sufficient numbers of female patients with a tumor of the lower extremity available for this comparative study. All patients were stage I and none received prophylactic lymph node dissection. Age, tumor location, tumor thickness, depth of infiltration and ulceration were taken into account and the factors studied within this group were 10-year disease-free rate, 10-year survival rate, and local and regional recurrences. Women with a melanoma of the leg (excluding the foot) who had been treated by excision and adjuvant regional perfusion, had a significantly better 10-year disease-free rate (P less than 0.0005), a significantly higher 10-year survival rate (0.010 less than P less than 0.025) and significantly fewer local/regional recurrences (P less than 0.0005) than women treated by wide local excision only. For tumors of the foot, however, no significant differences in 10-year disease-free rate, 10-year survival rate or local/regional recurrences were observed after perfusion.

Adult↗
PubMed1983

Indications for elective groin dissection in clinical stage I patients with malignant melanoma of the lower extremity treated by hyperthermic regional perfusion.

From 1973 through 1979, inguinal node biopsy was performed to stage the disease process in 179 clinical Stage I patients with malignant melanoma of the lower extremity, who were all treated by hyperthermic regional perfusion as well. Of the 179 tumors, 12% were intermediate risk (0.75-1.44 mm) and 88% were high risk (greater than or equal to 1.5 mm); all had a Clark level of IV or V. The Rosenmüller node at the caudal margin of the saphenous hiatus was elected for inguinal node biopsy. This biopsy supplies a fair amount of information about the entire inguinal node region: a malignant node was found in 16 patients (9%); no other metastatic nodes were found in 11 (73%) of 15 subsequent therapeutic node dissections; the 16th had metastatic parailiac nodes as well. Two patients of the remaining 163 had only metastatic parailiac nodes, without metastatic inguinal nodes. Of the remaining 161 histologic Stage I patients, 23 (14%) developed inguinal node metastases in the course of the follow-up. In 17 (74%) these metastases occurred within 2 years of perfusion. Ten of the 23 showed simultaneous general metastases. The vast majority of the inguinal node metastases developed in patients with a tumor greater than or equal to 5 mm. The 5-year survival was 81%, i.e. 84% in females versus 69% in males, the difference being significant (P less than 0.01). A tumor thickness greater than or equal to 5 mm implied a significantly less favorable prognosis as to development of inguinal node metastases associated with general metastases than a tumor thickness less than 5 mm. The benefit of the inguinal node biopsy was related to the difference in 5-year survival between the group with inguinal node metastases at perfusion (69%) and the group who developed inguinal node metastases during the follow-up (24%). The difference was great (45%) but statistically not significant. The data seem to warrant the conclusion that, after perfusion therapy, inguinal node biopsy is sufficient to stage the disease process at a tumor thickness less than or equal to 5 mm. Given a tumor thickness less than or equal to 5 mm, elective groin dissection might improve the chance of survival.

Biopsy↗
PubMed1982

Hyperthermic regional perfusion with melphalan and a combination of melphalan and actinomycin D in the treatment of locally metastasized malignant melanomas of the extremities.

From September 1969 through 1979, 68 patients with already locally metastasized malignant melanomas of the extremities were treated by hyperthermic regional perfusion and local excision(s). Of these, 53 patients could be evaluated after a follow-up of at least 2 years: 31 had been perfused with melphalan and 22 with melphalan in combination with actinomycin D. Local recurrence rates were about the same in both groups: 32 versus 33%. The same applied to the symptom-free interval between perfusion and local recurrence: about 12 versus about 13 months. Virtually all recurrences in both groups (90 versus 85%) were seen within 2 years. The interval between perfusion and systemic metastization was also roughly the same: about 25 versus about 23 months. These results indicate the need for better chemotherapeutics in order to achieve further improvement. The results of these perfusions were otherwise by no means disappointing, and hyperthermic regional perfusion is indicated in the treatment of patients with locally metastasized malignant melanomas.

Adult↗