Isolated limb perfusion: The European experience

More than 40 years after its design in the United States isolated limb perfusion is still a very promising and progressing technique. In Europe, very interesting developments have been made. The optimalization of the method, especially by using continuous leakage monitoring and using the drug melphalan, yielded good results in melanoma and the addition of TNF is the first demonstration of an active antiangiogenic treatment in the clinic. Furthermore, in sarcomas that are not amenable to surgery, ILP with TNF and melphalan represents a neoadjuvant treatment for limb-sparing surgery. Being a regional treatment ILP is not expected to significantly influence survival. This treatment modality is worthwhile to pursue in the local control of regionally advanced tumors, avoiding unnecessary mutilation.