Isolated Limb Perfusion of an Irradiated Foot With Tumor Necrosis Factor, Interferon, and Melphalan

Abstract

A 57-year-old woman presented with the second recurrence of a high-grade malignant fibrous histiocytoma of the right foot, following previous local resection plus curative adjuvant radiotherapy. The first recurrence of the lesion was treated by isolated limb perfusion with cisplatin; the second recurrence was treated by isolated limb perfusion with tumor necrosis factor, interferon, and melphalan. The tumor and the area that had been irradiated showed a bluish color a few hours after tumor necrosis factor perfusion. Amputation of the right foot and leg below the knee had to be performed because of severe necrosis.

Complications of combined radiotherapy and isolated limb perfusion with tumor necrosis factor alpha ± interferon gamma and melphalan in patients with irresectable soft tissue tumors

“…Blistering and necrosis developing in a previously irradiated area, however, have been reported after ILP and seem compatible with reports by other authors on the reciprocally potentiated effects of cytostatic drugs and radiotherapy [4,34,35].…”

Isolierte Extremitätenperfusion mit TNFα und Zytostatika: eine Revolution in der Behandlung lokal fortgeschrittener Weichgewebssarkome der Extremitäten

“…Following a report on a necrosis of a previously irradiated foot after TNF-based ILP [139], concerns were raised that radiation-induced damage of the normal tissue's microvasculature might render it susceptible to the toxic effects of the TNF=melphalan combination. However, in a series of 26 patients with recurrent tumors in a previously irradiated field, all candidates for amputation, a 70% overall response and a 65% limb salvage rate at a median follow-up of 22 months was shown, with only mild to moderate regional toxicity [140].…”

Efficacy of hyperthermic isolated limb perfusion for extremity-confined recurrent melanoma

“…Seven complications directly or indirectly resulting from the HILP procedure were noted: (1) deep venous thrombosis; (2) seroma with poor wound healing; (3) cellulitis; (4) nerve damage; (5) hepatitis; (6) bone marrow depression; and (7) necrosis following perfusion of a previously radiated extremity. 1,6,10 Various surgeons have reported successful treatment using the HILP technique. Edwards and colleagues reported treatment failure of only 28% for perfusion patients, compared to a failure rate of 48% for other surgical techniques.…”