The Role of Limb Perfusion in the Management of Malignant Melanoma

Abstract

The original work with chemotherapy by regional perfusion began at Tulane University in 1957 [1, 2]. Based on previous work using indwelling arterial catheters to deliver chemotherapy directly into tumor bearing regions [3–5], the use of an extracorporeal oxygenated circuit was adapted to maintain and deliver a concentrated chemotherapeutic agent to the isolated tumor bearing region, obtaining a prolonged high dose tumor exposure with minimal systemic effects. Drug dosages were limited only by local tissue tolerance. The technique was applied in a variety of tumor types, and to most areas of the body, but the most dramatic responses were seen in melanoma of the extremities, for which no good systemic agents existed at that time. Objective responses were seen in more than half of the melanoma patients following limb perfusions, a response rate still unequalled by any systemic agent or combination of agents.