Minimally invasive isolated limb perfusion – technical details and initial outcome of a new treatment method for limb malignancies

Figures & data

Figure 1. Schematic representation of vascular access for ILP and ILI.

Table 1. Patient and treatment characteristics.

Age	Sex	Diagnose	Co-morbidity	TNM	Priortreatment	No of tumours /Largestdiameter(mm)	Perfusedvessels	Treatment	Op time /Perfusiontime (min)	Temp(C°)	Medianflow rate(ml/min)	Leakage(%)	Complications(Clavien-Dindo)	Hospitalstay(days)	Responseat 3 months(WHO)	Toxicity	Follow-up(months)	Treatmentafter ILP	Status
48	F	Melanoma	None	T2N2cM0	None	1/110	Femoral	TNF-α + Melphalan	225/90	39.6	500	0.1	II	14	SD	III	24	Immunotherapy	AWD
60	F	Melanoma	Diabetes type II	T2N2cM0	Surgery	50/15	Femoral	Melphalan	164/60	40.0	711	0.0	0	4	CR	II	14	None	NED
87	M	Melanoma	Prostate cancer,Diabetes type II	T3N2cM0	Surgery	1/8	Femoral	Melphalan	152/60	37.5	270	0.0	0	3	CR	II	18	None	NED
50	M	Melanoma	None	T4N2cM0	Surgery	2/10	Brachial	Melphalan	150/60	39.9	110	0.0	II	5	SD	III	16	Immunotherapy	NED
71	M	Melanoma	None	TxN2cM0	Surgery	6/15	Femoral	Melphalan	163/60	38.4	610	3.2	0	5	CR	III	10	None	NED
61	M	SCC	Mb Bechterew,Psoriasis artritis	T4N0M0	Surgery	4/20	Femoral	Melphalan	195/60	39.9	610	0.0	0	2	CR	II	14	None	NED

SD: stable disease; CR: complete response; AWD: alive with disease; NED: no evidence of disease; SCC: Squamous cell carcinoma.

Figure 2. Catheters in place with extracorporeal circuit connected during a femoral MI-ILP.

Figure 3. Comparison of flow rates and pressure loss between catheters used in ILP and MI-ILP.

Table 2. Comparison of ILP, MI-ILP and ILI with approximate values of important parameters.

	ILP	MI-ILP	ILI
Vascular access	Open surgery	Percutaneous	Percutaneous
Arterial catheter size	10–12Fr	10–12Fr	6–8Fr
Venous catheter size	16–18Fr	12–14Fr	6–8Fr
Perfusion time	60–90 min	60–90 min	30 min
Flow rate	250–1200 ml/min	250–1200 ml/min	60–120 ml/min
Perfusion pressure	Systemic pressure (100 mmHg)	Systemic pressure (100 mmHg)	Low pressure
Common drugs used	Melphalan with/without TNF-alpha	Melphalan with/without TNF-alpha	Melphalan with/without actinomycin-D
Melphalan dose	10–13 mg/L limb volume	10–13 mg/L limb volume	7.5–10 mg/L limb volume
Leakage risk	High	High	Low
pH	Normal	Normal	Acidotic
Oxygenation	High	High	Low
Temperature	40 °C	40 °C	37–39 °C