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Isolated limb perfusion (ILP) for malignant melanoma

Equipment

  • Heart/lung machine such as roll pump, oxygenator, and warming system
  • Gamma detector
  • Software for continual monitoring of possible leakage.
  • Surgery tray
  • Vein instruments 
  • Vascular cannulas
  • Temperature probes
  • Tourniquet
  • Warming blanket 

Medications

Melfalan is a suitable medication for ILP treatment because of its short half-life, low endothelial toxicity, limited cell cycle specificity, and relative linear dose response conditions of cytotoxicity. 

Optimal dosage:

  • 10 mg/l extremity volume for upper extremity
  • 13 mg/l extremity volume for lower extremity

Tumor necrosis factor (TNF-a) is used only for melanoma metastases with tumor size > 2 cm in diameter. TNF leads to selective endothelial damage to tumor veins and conserves normal ones. The medication is very toxic when given systemically and can lead to septic shock. 

Dosage for both upper and lower extremity:

  • 2–4 mg per perfusion regardless of extremity

Hyperthermia

Hyperthermia increases the toxicity effect of both melfalan and TNF. 

Temperatures over 41°C lead to high regional toxicity, therefore mild hyperthermia with temperatures between 38.5-39.5°C are used.

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