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Long-term functional morbidity after mild hyperthermic isolated limb perfusion with melphalan.

B C Vrouenraets¹, G J in't Veld, O E Nieweg

¹Department of Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek ziekenhuis), Amsterdam, The Netherlands.

European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

|October 21, 1999

Summary

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Isolated limb perfusion (ILP) with melphalan for melanoma may cause long-term functional issues, particularly ankle stiffness and lower limb atrophy. These risks must be balanced against ILP

Area of Science:

Oncology
Surgical Oncology
Clinical Trials

Background:

High-risk melanoma and sarcoma require effective adjuvant therapies.
Isolated limb perfusion (ILP) with melphalan is a treatment option for limb malignancies.
Long-term functional outcomes of ILP are not fully understood.

Purpose of the Study:

To evaluate long-term functional morbidity in patients treated with adjuvant ILP for primary limb melanoma.
To compare functional outcomes between ILP and wide excision alone.

Main Methods:

Prospective randomized trial (EORTC) involving 65 patients (36 ILP, 29 wide excision only).
Assessment of limb circumference and joint mobility at a mean of 48 months post-treatment.
Comparison of functional measurements between treated and contralateral limbs.

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Main Results:

No severe complaints reported; ankle extension was significantly restricted in ~40% of ILP patients.
Minimal shoulder abduction impact; lower limb atrophy observed in 24% of ILP patients.
Edema occurred in 4/5 ILP patients who also had lymph-node dissection.

Conclusions:

ILP for limb melanoma/sarcoma carries a risk of long-term functional morbidity.
Ankle mobility and lower limb atrophy are key concerns.
Weigh the functional risks against the potential benefits of ILP.