ISOLATED LIMB PERFUSION FOR MALIGNANT-MELANOMA

The technique of isolated limb perfusion (ILP) for the treatment of ex tremity melanoma has been used in the United States for almost 40 year s. The treatment is based upon the ability to isolate the circulation of the afflicted extremity from the systemic circulation, thereby allo wing dose-intensive delivery of anti-cancer agents to the limb while e liminating systemic exposure and toxicity. A number of agents have bee n used in ILP, however, the bulk of clinical experience has been with the allylating agent melphalan, typically used under conditions of mil d hyperthermia. Despite considerable clinical experience, there has be en a lack of agreement about the role of ILP in the prophylaxis agains t or the treatment of recurrent extremity melanoma. Recently there has been renewed interest in the use of ILP based upon the very promising results using a combination of tumor necrosis factor, melphalan, and interferon-gamma which have produced complete response (CR) rates of a lmost 90%. The utility of this regimen in extremity melanoma is active ly being evaluated by clinical trials in the United States and Europe. (C) 1996 Wiley-Liss, Inc.