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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.
Summary
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.
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.