REGIONAL ISOLATED LIMB PERFUSION IN PATIENTS WITH MALIGNANT-MELANOMA

In this overview the Amsterdam/Rotterdam 'controlled' normothermic (ti ssue temperatures 37-38-degrees-C) perfusion technique is described. T he benefit of the widely used so-called 'mild' hyperthermia (39-40-deg rees-C) is queried. A plea is made to report acute regional toxicity a fter perfusion according to Wieberdink's grading system for uniformity . Perfusion has a well-established role in the treatment of locally in operable melanoma. As an adjunct to surgery, benefit has also been sho wn in resectable stage II-III recurrent melanoma. For stage I primary melanoma the results of the ongoing EORTC/WHO adjuvant trials are eage rly awaited. In measurable disease an overall response rate of about 8 0% (with equal proportions of complete and partial remissions) can be obtained by single normothermic or 'mild' hyperthermic perfusion. Perf usion strategies that have been investigated to improve the complete r esponse rate are discussed: the application of other cytostatics than melphalan, the role of repeat perfusions, perfusion with melphalan at borderline 'true' hyperthermic temperatures (40.5-42-degrees-C), seque ntial perfusion applying 'true' hyperthermia (42-43-degrees-C) and mel phalan separately, and perfusion with the combination of rTNF-alpha, I nterferon-gamma and melphalan. The ideal of a 100% complete remission rate has been approached in several perfusion strategies but the durat ion of remission is still rather short. The main issue for the immedia te future will therefore be prolongation of the limb recurrence-free i nterval.