Technique and results of regional hyperthermic cytostatic arm perfusion for malignant melanoma

Abstract

Isolated hyperthermic cytostatic limb perfusion has been established as an efficient procedure for the treatment of malignant melanoma of the limbs. However, perfusions of the upper extremities are generally carried out much less frequently than would be expected given the distribution pattern of malignant melanoma and sarcoma. Thus, isolated descriptions of treatment results for perfusion of the upper extremities are not available. Between 1991 and 1994, arm perfusions using melphalan 1.0 mg/kg body weight were given to 14 patients with malignant melanoma, using the standardized method of perfusion described herein. Within an average observation period of 34.9 months (range, 12-65 months), 11 (78.7%) of the 14 patients who had M.D. Anderson stage II-IV melanoma remained free of local recurrence. In fact, 10 (71.6%) of the patients were still alive at the end of the observation period. None of the 14 patients showed any systemic adverse effects, although 1 patient developed a lymphedema 32 months after perfusion and 2 patients showed a postoperative temporary neurologic deficit. These results demonstrate that isolated perfusion of the upper limb with heat and melphalan under standardized conditions remains the treatment of choice for melanoma of the arm, as for melanoma of the leg, without a higher rate of complications.

Isolated limb infusion for local control of lower limb melanoma: Radiologic aspects

“…At that time, we did not have any cases of isolated arm infusion. A review of the published studies suggests that, for unknown reasons, upper limb ILI is carried out less frequently than lower limb ILI, although it is equally effective 8 …”

Evaluation of the efficacy and toxicity of upper extremity isolated limb infusion chemotherapy for melanoma: An Australian multi-center study

“…Only one small ILP report focusing on upper limb procedures specifically has been published previously and two larger ILP studies have performed a comparative analysis of upper-limb and lower-limb procedures, with no differences in outcomes. (19,20,29) Although response rates after ILP were higher overall compared to ILI (albeit in unmatched patient groups), there was no impact on survival while limb toxicity was more severe.…”