Limb perfusion, hyperthermic

Perfusion of a limb with cytostatic drugs under hyperthermia (39-40 °C). Use in malignant melanoma with multiple satellites and/or in transit metastases. Remission rates are given as 50-80%. The use as adjuvant therapy is still under review. The therapeutic procedure is only used in special centres.

Representation of the peripheral vessels of the affected extremity. Insertion of catheters into the main vein and artery (e.g. arteria and vena femoralis) and creation of an extracorporeal circulation with pump oxygenator. Decoupling the limb circulation from the body circulation by applying a tourniquet in the groin. Heating of the blood to the desired temperature and addition of the cytostatic drug. Perfusion over one hour, longer perfusion time increases the complication rate. Common cytostatic drugs are melphalan (alkeran) and cisplatin (e.g. Cisplatin Lsg. medac). In some centres, good success was shown with the perfusion of tumour necrosis factor in combination with melphalan, which was superior to the therapy with melphalan alone (level of evidence IIB).

NW, both systemic (e.g. hair loss, leakage problem, leukocyte loss) and local (damage to the arteries, veins and lymphatic vessels), can be expected in some patients.