Regional chemotherapy by isolation-perfusion.

For 20 years, regional chemotherapy by isolation-perfusion has been employed for limb and selected pelvic lesions using high doses of drugs without systemic side effects. When used prophylactically, it is combined with local excision of the lesion and primary closure reducing the number of skin grafts and recurrence rate for local or intransit disease. Overall survival rate is better than for patients treated by surgery, and perfusion patients also do better with secondary therapy. For advanced melanoma patients with intransit metastasis, a 50% five-year survival may be less than expected. For patients with soft tissue sarcomas < 5 cm in diameter, the five-year survival is just under 80% and just over 40% for those > 5 cm. Complications may occur in 10% of patients treated by prophylactic perfusion, and the rate increases as the dosage and number of drugs are increased, up to a 37% complication rate for patients with advanced disease in a limb.