For people with advanced but localized melanoma, delivering potent chemotherapy to just the limb with the cancer is highly effective both in terms of local disease control and survival, Dutch clinicians report. This approach, they say in the December Annals of Surgery, “should be considered in all cases of limb-threatening tumors or in situations where simple surgical procedures to obtain local control fail.” The technique involves clamping off the affected limb with a tourniquet, while maintaining circulation in the isolated region with an external pump similar to a heart-lung machine. The limb can then be perfused with very high concentrations of chemo drugs, notably with a powerful agent called tumor necrosis factor, TNF. In their article, Dr. Dirk J. Grunhagen and colleagues from the Daniel den Hoed Cancer Center in Rotterdam report their experience with 100 TNF-based isolated-limb perfusions performed over a 12-year period in 87 patients with advanced melanoma.
