Isolated limb perfusion as a treatment option for rare types of tumours

Figures & data

Figure 1. These images show a Merkel cell carcinoma before and 6 weeks after isolated limb perfusion. Almost all tumours have disappeared and the last necrotic tumour fell off; at 3 months there was no evidence of disease left. Image reproduced with permission from the patient.

Table 1. A summary of 12 patients treated with isolated limb perfusion.

Patient	Diagnosis	Primary localisation	Previous treatment	Perfusion access	Perfusion time (min)	T (°C)	Drug	Response	Local toxicity (Wieberdink)	Lymph node dissection	Surgical resection after ILP	Complications	Local recurrence	General recurrence	Survival
1	Merkel cell tumour	Arm	Primary surgery RTx, CTx	Brachial	90	40	TNF 1 mg + Mel 35 mg	CR	II	No	No	No	No	Yes 12 months	12 months (AWD)
2	Merkel cell tumour	Forearm	Primary surgery RTx	Axillary	90	40	TNF 3 mg + Mel 40 mg	PR	II	No	No	No	No	Yes 2 months	2 months (DOD)
3	Merkel cell tumour	Leg	RTx	Femoral	90	40	TNF 3 mg + Mel 60 mg	CR	II	No	No	No	No	No	144 months (NED)
4	Merkel cell tumour	Calf	Primary surgery	External iliac	120	41.5	Mel 50 mg	CR	III	Yes	No	Seroma Transient peroneus paresis	No	No	70 months (DOC)
5	Squamous cell carcinoma	Elbow	No previous treatment	Axillary	90	40	TNF 3 mg + Mel 35 mg	SD	II	Yes	Yes	Seroma	Yes 7 months	Yes 25 months	27 months (DOD)
6	Squamous cell carcinoma	Leg	No previous treatment	Femoral	90	40	TNF 4 mg + Mel 50 mg	CR	II	Yes	No	No	Yes 4 months	No	18 months (DOC)
7	Desmoid tumour	Arm	RTx, CTx	Brachial	90	40	TNF 1 mg + Mel 40 mg	SD	II	No	No	No	No	No	20 months (AWD)
8	Desmoid tumour	Thigh	Primary surgery	External iliac	90	40	TNF 4 mg + Mel 80 mg	PR	II	No	Yes	No	No	No	63 months (NED)
9	Desmoid tumour	Thigh	No previous treatment	External iliac	90	40	TNF 4 mg + Mel 120 mg	PR	II	Yes	Yes	No	Yes 14 months	No	145 months (AWD)
10	B-cell lymphoma	Leg	RTx, CTx	Femoral	90	40	TNF 4 mg + Mel 120 mg	CR	II	No	No	No	No	Yes 2 months	3 months (DOD)
11	Pigmented villonodular synovitis	Knee	Primary surgery	Femoral	60	40	Mel 95 mg	SD	II	No	Yes	Wound infection	Yes 3 months	No	31 months (NED)
12	Giant cell tumour	Knee	Primary surgery	Femoral	90	40	TNF 4 mg + Mel 80 mg	CR	III	No	Yes	Transient peroneus paresis	No	No	114 months (NED)

AWD: alive with disease; CR: complete response; CTx: chemotherapy; DOC: dead of other cause; DOD: dead of disease; ILP isolated limb perfusion; Mel: melphalan; NED: no evidence of disease; PR: partial response; RTx: radiotherapy; SD: stable disease; TNF: tumour necrosis factor-alpha.