Tourniquet Infusion Versus Hyperthermic Perfusion

Abstract

The tourniquet infusion method was compared with hyperthermic perfusion in canine limbs by using Adriamycin, actinomycin-D, and melphalan. Tourniquet infusion provided comparable tissue levels with Adriamycin and significantly higher levels with actinomycin-D and melphalan in the treated extremity than hyperthermic perfusion with the same drugs and dosages. Higher systemic leak was observed, more so with melphalan, with the tourniquet infusion method. Tourniquet infusion has caused complete regression of four malignant tumors involving extremities (one malignant melanoma, two Kaposi's sarcomas, one squamous cell carcinoma) and partial greater than 50% regression of nine tumors (three malignant melanomas, three squamous cell carcinomas, one malignant schwannoma, one malignant fibrohistiocytoma, one liposarcoma) followed by excision of residual tumor. Five patients with extremity sarcomas precluding adequate surgical margins were treated preoperatively with the this method. Longer follow-up is needed, as is a larger number of patients for a valid comparison of tourniquet infusion with hyperthermic perfusion.

Tourniquet infusion chemotherapy for extremity in-transit lesions in malignant melanoma

“…It has been estimated that TI provides 50-100 times higher drug levels in the regional tissues over those observed with simple intraarterial infusion without hemodynamic alterations (1,3). The reported 35% recurrence-free rate for the treated extremity on prolonged follow-up in the present series with TI, and 5-year survival rate of 30%, are lower than those observed in some series after perfusion.…”

“…The tourniquet infusion (TI) method provides levels comparable with those of perfusion in the canine model (1)(2)(3)(4). However, intraarterial chemotherapy provides the alternative of simplicity and the potential for repeat courses.…”

Treatment of Locally Advanced Melanoma by Isolated Limb Infusion with Cytotoxic Drugs

“…Since the half time of melphalan is 15 to 20 minutes and both melphalan and actinomycin-D are quickly absorbed by the tissues of the isolated limb, a relative short circulation time of 30 minutes is sufficient [27, 28]. …”

Isolated Limb Perfusion in the Management of Patients With Recurrent Limb Melanoma: An Important but Limited Role

“…Another alternative technique was described as tourniquet infusion but, again, response rates were low and systemic drug effects were inevitable because only very brief occlusion of venous outflow from the limb was achieved. 7 At the Sydney Melanoma Unit, we introduced in 1992 an alternative technique that we called isolated limb infusion (ILI). This has produced results generally comparable to those achieved by ILP, but without requiring complex equipment, many staff, and long periods of operating time.…”

“…We have found the technique to be well tolerated, even by frail and elderly patients, allowing effective palliative treatment to be given to individuals who would not be considered fit for treatment by conventional ILP. Details of the ILI procedure have been reported elsewhere, 8 but it is, in essence, a very low flow ILP performed without oxygenation via standard radiological catheters (6)(7)(8). These are inserted percutaneously in the radiology department prior to the actual ILI procedure in the operating room, which involves only 20 -30 minutes of drug exposure.…”