Isolated limb perfusion with Melphalan is the best treatment option to control symptomatic multiple small in-transit metastases. When lesions are bulky, Isolated Limb Perfusion (ILP) with Tumor Necrosis Factor (TNF) + Melphalan is superior as in soft tissue sarcoma. TNF changes the pathophysiology, greatly enhances the uptake of Melphalan and destructs selectively the vasculature of large tumors. To date, ILP is not indicated in an adjuvant setting.,
Surgical Clinics of North America
Department of Surgery

Eggermont, A., van Geel, A., de Wilt, J., & ten Hagen, T. (2003). The role of isolated limb perfusion for melanoma confined to the extremities. Surgical Clinics of North America (Vol. 83, pp. 371–384). doi:10.1016/S0039-6109(02)00095-6