Chemotherapy by Isolated Regional Perfusion for Melanoma of the Limbs

The original work with chemotherapy by regional perfusion began at Tulane University in 1957 (Creech et al. 1958; Ryan et al. 1958). Based on previous work using indwelling arterial catheters to deliver chemotherapy directly into tumor-bearing regions (Bierman et al. 1950; Klopp et al. 1950; Sullivan et al. 1953), the use of an extracorporeal oxygenated circuit was adapted to maintain and deliver a chemotherapeutic agent to the isolated tumor-bearing region, obtaining high-dose tumor exposure, with minimal systemic effects. Drug dosages were limited only by the local tissue tolerance. The technique was applied to a variety of tumor types, and in most areas of the body, but the most dramatic responses were seen in melanoma of the extremities, for which no good systemic agents existed at that time. Objective responses were seen in more than 50% of melanoma patients following limb perfusions, a response rate still unequaled by any systemic agent or combination of agents.