An isolated limb infusion technique: a guide for the perfusionist

Area of Science:

• Oncology
• Surgical Oncology
• Cancer Therapy

Background:

• Isolated limb perfusion (ILP) with chemotherapy has treated extremity melanomas since 1958.
• Hyperthermia combined with melphalan enhanced cytotoxicity, leading to its clinical use in the 1960s.
• Hyperthermic-isolated limb perfusion (HILP) became the standard for advanced melanoma due to its effectiveness and lack of systemic options.

Purpose of the Study:

• To compare the efficacy and safety of isolated limb infusion (ILI) with hyperthermic-isolated limb perfusion (HILP) for advanced melanoma.
• To evaluate ILI as a less invasive alternative to HILP.

Main Methods:

• HILP: Open surgical dissection and peripheral vessel cannulation.
• ILI: Less invasive percutaneous catheter insertion via femoral vessels under angiographic guidance.
• Both techniques utilize melphalan chemotherapy, with ILI potentially inducing local hypoxia and acidosis to potentiate drug effects.

Main Results:

• HILP is associated with moderate morbidity, including potential blood transfusions, drug leak, infection, and vascular/nerve damage.
• ILI demonstrates significantly reduced morbidity compared to HILP.
• Response rates for ILI appear similar to HILP and markedly superior to systemic chemotherapy.

Conclusions:

• ILI represents a less invasive approach to regional cancer therapy for extremity melanomas.
• ILI offers comparable patient outcomes to HILP with substantially lower morbidity.
• ILI is a potentially more desirable treatment option for advanced melanoma, with a potential role for perfusionists.