Low-dose tumour necrosis factor-alpha (TNF-alpha) and melphalan in hyperthermic isolated limb perfusion. Results from...

Nine patients with soft tissue tumours of the lower limb not amenable to treatment other than by isolated limb perfusion (ILP) or amputation underwent ILP at the level of the superficial femoral vessels, using a combination of recombinant TNF-alpha and melphalan. In seven patients in whom tumours were superficial, sloughing and necrosis were apparent within 48 h of perfusion. All patients experienced a complete tumour response. There were no systemic side effects associated with the use of TNF-alpha, although local side effects, particularly oedema, were pronounced. Four patients ultimately required amputation, three because of large soft tissue defects resulting from necrosis of tumour and overlying skin and one because of tumour recurrence.