Clinical Utility of TNF-based Isolated Limb Perfusion to achieve Limb Salvage

Isolated limb perfusion (ILP) with melphalan is effective in the treatment of small multiple melanoma in-transit metastases and is utilized widely for this indication. The technique achieves regional drug concentrations 15–25 times higher than systemic administration and is without systemic side effects 1, 2. However, the treatment is much less effective against bulky melanoma metastases and has uniformly failed in the treatment of irresectable extremity soft tissue sarcomas. The addition of tumour necrosis factor-alpha (TNF-a) to this treatment approach has changed this situation dramatically and has greatly expanded the successful application of ILP. TNF-based ILP (TM-ILP) can avoid amputations regardless of the tumour size and type.