Many patients are affected by tumors which are confined to the arms or legs which are not amenable to surgical removal. The most common examples of this are melanoma (approximately 1,000 new cases of advanced extremity disease each year) and sarcoma (approximately 10,000 cases each year). For many of these patients in the absence of regional therapy the only alternative is a major amputation. After regional hyperthermic perfusion therapy these tumors may disappear completely and require no further therapy, or may shrink to a stage where surgical removal is then possible. Isolated limb perfusion has been around for over 50 years but has been slow to develop because of the lack of a centralized training system for surgeons in this technique. It is a recognized standard procedure for melanoma which has spread throughout the arm or leg. Despite this, it is only performed at a limited number of centers across the country. Many patients undergo amputation or develop terrible complications from advanced tumor in the extremity that would otherwise be amenable to regional hyperthermic cancer therapy if it was available to them. The Center of Excellence would act as a national referral center for these patients as well as train surgeons within their community to learn this technique.

The isolated limb perfusion is performed in the operating room with the patient asleep under general anesthesia. An operation is performed to expose the blood vessels in the arm or leg. One tube is placed into the artery which feeds blood into the leg and a second tube is placed into the vein which drains blood from the leg. These tubes are connected to a circuit which includes a pump, a heat exchanger, and an oxygenator. A tourniquet is then applied tightly at the root of the arm or leg to avoid any mixing of the circulation from the rest of the body. The blood within the leg is then circulated through the pump, heated, and then recirculated back into the leg. This continuous flow recirculation continues for 60 to 90 minutes. A drug, usually melphalan, is added to the circuit at the beginning of the perfusion. At the end of the perfusion the drug is completely washed out of the limb, and the limb's circulation is reestablished in communication with the rest of the body. In this way minimal to no drug is released into the circulation, thereby avoiding common side effects.

Trials of this treatment in melanoma patients demonstrated that the tumors went away completely 50-80% of the time. We have dramatic examples of bulky, symptomatic tumors disappearing after a single 90-minute treatment. Some patients have been cured of their disease after a single treatment.