Thirty-five years of isolated limb perfusion for melanoma: Indications and results

Abstract

Isolated limb perfusion (ILP) for limb melanoma remains controversial despite its frequent use for over 35 years. To determine whether it has proven benefits, reported results have been reviewed. The value of adjuvant ILP cannot be determined from the multitude of retrospective studies on this subject. Preliminary results of the large European Organization for Research and Treatment of Cancer-World Health Organization-North American Perfusion Group trial suggest that patients with melanomas of 1.5-3.0 mm in thickness who do not undergo elective lymph node dissection may have a locoregional control benefit from ILP. However, as long as a definite survival advantage for ILP has not been demonstrated, such treatment does not seem justified for these patients. The value of prophylactic ILP after resection of recurrent limb melanoma is also scientifically unproven. The potential prevention of further limb recurrence for only a limited period of time, as demonstrated in a rather small Swedish trial, probably does not justify routine use of ILP in these patients; a large international trial will be needed to assess whether ILP provides a survival advantage. For those with locally inoperable limb melanoma, ILP appears to be the treatment of choice since it results in complete disappearance of all macroscopic disease in a substantial proportion of patients, removing the need for amputation and providing palliation of symptoms. However, high limb recurrence rates and short duration of response need improvement. Results of alternative treatments should be compared prospectively with those of ILP in this clinical situation.

Efficacy of repeat isolated limb infusion with melphalan and actinomycin D for recurrent melanoma

“…It has been suggested that severe acute limb toxicity after ILP correlates significantly with a higher risk of long-term morbidity, but this has not been observed in patients treated by ILI at the SMU. 3,9,30 In the current study, the median duration of response after repeat ILI was 11 months, with a median overall survival of 38 months. The increased survival observed after a CR after repeat ILI was most likely a reflection of the tumor biology.…”

“…In these patients, isolated limb perfusion (ILP) with melphalan is a suitable treatment option when other local treatments such as excision, cryotherapy, electrodesiccation, or laser ablation are no longer appropriate because of progressive disease. [1][2][3] Although results after ILP are satisfactory, the technique involves a complex and invasive surgical procedure with a substantial risk of complications. 4,5 Isolated limb infusion (ILI) has been developed at the Sydney Melanoma Unit as a simplified and minimally invasive alternative to ILP.…”

Isolated Limb Perfusion for Malignant Melanoma: Systematic Review on Effectiveness and Safety

“…With these aims, the circulation of the involved limb is isolated from the systemic circulation and connected to an extracorporeal system. Once high temperatures are reached, the chemotherapy drugs, mainly melphalan and tumor necrosis factor (TNF), are then administered to the patient through the perfusion circuit [3,4].…”

Isolated limb perfusion for melanoma

“…At the beginning of the perfusion era (mid 1950s and 1960s), ILP was associated with lower remission rates; complete remission rates have increased by approximately 10% during the last decade [3]. This may be attributed not only to the fact that most of the early ILP procedures were probably performed under less effective hypothermic conditions [1], but also because ILP schedules have become more sophisticated.…”

“…Nowadays, such ablation is required only rarely, usually for extensive or deeply in®ltrative lesions associated with severe pain, bleeding, and odor that do not respond to ILP. After treatment with ILP using melphalan, an average complete remission rate of approximately 54% can be obtained [3].…”