EFFICACY OF HYPERTHERMIC ISOLATED LIMB PERFUSION FOR EXTREMITY-CONFINED RECURRENT MELANOMA

Background: Recurrent melanoma of the extremity has been treated by lo cal excision, systemic chemotherapy, amputation, or a combination of t hese approaches. Hyperthermic isolated limb perfusion (HILP) provides a method of limb preservation through isolation, allowing the administ ration of chemotherapy in higher doses than is possible through system ic treatment. Methods: An experimental group of 59 HILP patients with melanoma recurrences of the extremity was studied prospectively. A con trol group of 248 melanoma patients with similar recurrences was exclu ded from HILP because their recurrences were in non-extremity location s. The experimental group underwent HILP and excision; the control gro up had excision only. The experimental procedure consisted of vascular isolation of the affected extremity and a 1-hour perfusion with melph alan. Temperatures were maintained at 40 degrees C in the perfusion ci rcuit. Results: The HILP patients had a lower rate of locoregional rec urrence (P = .028) and demonstrated increased survival (P = .026) comp ared to the control group. In multivariate regression analysis, which included age, ulceration and thickness of the primary, and the treatme nt variable of perfusion, age (P = .02) and perfusion for the treatmen t of recurrence (P = .006) were significant predictors of survival. Co nclusions: HILP improves prognosis by sterilizing the treated extremit y, controlling locoregional disease, and perhaps preventing metastasis , thus having a positive impact on overall survival.