Isolated Limb Perfusion
Dear OncoLink "Ask The Experts,"
What is isolated limb perfusion? Can you tell me its indications, technique, and adverse effects?
Suzanne M. McGettigan, MSN, CRNP, AOCN, Board Certified Adult Nurse Practitioner and a Certified Oncology Advanced Practice Nurse, responds:
Isolated Limb Perfusion, or ILP, is a procedure used to treat locally metastatic melanoma , specifically in-transit metastases. In-transit metastases are those lesions that occur in between the original melanoma site and the nearby lymph node basin. For example, if a person's primary melanoma was on the right calf, the lymph node basin draining that area would be in the right groin. In-transit metastases would thus include any subcutaneous melanoma lesions that occur between the original site and the lymph nodes, such as on the thigh.
Treatment of in-transit metastases can include surgical resection (if feasible), isolated limb perfusion, systemic chemotherapy, systemic biologic therapy, or radiation therapy.
The main goal of ILP is to treat the known melanoma lesions or metastases in a limb with very high doses of chemotherapy, yet preventing that chemotherapy from being absorbed systemically (meaning in the rest of the body). By doing this, high doses of chemotherapy can be delivered to the affected limb, while keeping the side effects to a minimum.
During ILP, the vascular supply to and from the affected limb is temporarily cut off from the rest of the body. This is done through use of a type of tourniquet. The ILP procedure is performed by a surgeon while the patient is under general anesthesia. In addition to the chemotherapy that is given into the main artery of the involved extremity, the affected limb is often warmed. This warming is thought to enhance the effectiveness of the chemotherapy. The chemotherapy is then allowed to dwell in the affected limb for a specific period of time, usually 60 minutes, and then drained.
Side effects from ILP include those typically associated with general anesthesia. Additionally, other side effects include: risk for infection at the site of catheter insertion, muscle stiffness and atrophy, skin rash and peeling, nerve damage resulting in peripheral neuropathy and pain , and swelling ( lymphedema ) in the affected extremity. It is possible that the chemotherapy could enter the systemic circulation, but the patient is monitored very closely to prevent this from happening. Generally, this procedure is well tolerated by patients and has shown promise in treating locally recurrent disease.