Efficacy of hyperthermic isolated limb perfusion for extremity-confined recurrent melanoma.


Journal Article

BACKGROUND:Recurrent melanoma of the extremity has been treated by local excision, systemic chemotherapy, amputation, or a combination of these approaches. Hyperthermic isolated limb perfusion (HILP) provides a method of limb preservation through isolation, allowing the administration of chemotherapy in higher doses than is possible through systemic treatment. METHODS:An experimental group of 59 HILP patients with melanoma recurrences of the extremity was studied prospectively. A control group of 248 melanoma patients with similar recurrences was excluded from HILP because their recurrences were in non-extremity locations. The experimental group underwent HILP and excision; the control group had excision only. The experimental procedure consisted of vascular isolation of the affected extremity and a 1-hour perfusion with melphalan. Temperatures were maintained at 40 degrees C in the perfusion circuit. RESULTS:The HILP patients had a lower rate of locoregional recurrence (P=.028) and demonstrated increased survival (P=.026) compared to the control group. In multivariate regression analysis, which included age, ulceration and thickness of the primary, and the treatment variable of perfusion, age (P=.02) and perfusion for the treatment of recurrence (P=.006) were significant predictors of survival. CONCLUSIONS:HILP improves prognosis by sterilizing the treated extremity, controlling locoregional disease, and perhaps preventing metastasis, thus having a positive impact on overall survival.

Full Text

Duke Authors

Cited Authors

  • Brobeil, A; Berman, C; Cruse, CW; De Conti, R; Cantor, A; Lyman, GH; Joseph, E; Rapaport, D; Wells, K; Reintgen, DS

Published Date

  • June 1998

Published In

Volume / Issue

  • 5 / 4

Start / End Page

  • 376 - 383

PubMed ID

  • 9641461

Pubmed Central ID

  • 9641461

Electronic International Standard Serial Number (EISSN)

  • 1534-4681

International Standard Serial Number (ISSN)

  • 1068-9265

Digital Object Identifier (DOI)

  • 10.1007/bf02303503


  • eng