Lucy Wortham James lecture. Regional perfusion. Current sophistication, what next?

A review of the development of regional chemotherapy by perfusion is presented. Techniques have been developed for most regions of the body. Early response rates ranged from 48% for glioblastoma and 55% with carcinoma to 67% with soft tissue sarcoma and 84% with melanoma. By 1984, 1325 patients had been perfused 1509 times. The best responses have occurred with melanoma and soft tissue sarcoma of the limbs. Thus, at 10 years, the cumulative overall survival for Stage I melanoma of the limbs, combining regional perfusion and conservative excisional surgery, was 77%. The best results occurred in female patients with upper-limb disease (83%), and the poorest results were in male patients with lower-limb disease (53%). The overall 10-year survival for regional melanoma was 41%, ranging from 23% for in-transit metastases to 51% for patients with positive regional nodes treated by perfusion and regional lymph node dissection. The 10-year survival for perfusion and limb-sparing excision for soft tissue sarcoma was 65%. Advantages and complications are presented and discussed. Questions and plans for the future are reviewed.