Hyperthermic isolated limb perfusion: Does it still have a role?

Abstract

BACKGROUND: Hyperthermic-isolated limb perfusion (ILP) with melphalan is an established modality for the treatment of irresectable malignancy of an extremity, including melanoma. ILP isolates the affected limb from the systemic circulation, using an extracorporeal bypass circuit, and administering high-dose intra-arterial chemotherapy. While this technique remains the “gold standard” and is practiced at high-volume surgical oncology centers worldwide, as new systemic treatments have become available, it is timely to review the current place of regional chemotherapy. PATIENTS AND METHODS: Twenty-six ILPs were performed between 2006 and 2013 at a single center. Patient's parameters, clinical outcomes, and survival were evaluated. Twenty procedures were for melanoma, five for sarcoma, and one for extensive basal cell carcinoma (BCC). RESULTS: ILP was well tolerated with few intraoperative or postoperative complications. Within the melanoma group, limb toxicities were low with one Grade III and no severe (Wieberdink IV+) toxicities. Limb salvage was achieved in 2/5 sarcoma patients. At 6 weeks' postprocedure, 13 melanomas, two sarcomas, and the BCC patient reported a complete response (16/26). However, 5 years after the last procedure, and a median follow-up of 23 months, the majority of melanoma and all sarcoma patients went on to develop local recurrence or metastatic disease. CONCLUSIONS: ILP is a useful technique to provide high-dose chemotherapy to refractory limb malignancy to provide effective palliation, delay progression, or even obtain cure. However, as new effective systemic therapies emerge, the role of isolated regional chemotherapy (ILP and isolated limb infusion) needs to be reevaluated.