Isolated limb infusion with cytotoxic agents: a simple alternative to isolated limb perfusion

Semin Surg Oncol. Apr-May 1998;14(3):238-47. doi: 10.1002/(sici)1098-2388(199804/05)14:3<238::aid-ssu8>3.0.co;2-9.

Abstract

Isolated limb perfusion (ILP) with cytotoxic agents is an effective but complex procedure. Isolated limb infusion (ILI) has been developed as a simpler alternative. Catheters are inserted percutaneously into the axial artery and vein of the affected limb and a pneumatic tourniquet is inflated proximally. Cytotoxic agents are then infused through the arterial catheter and circulated with a syringe for 15 to 20 minutes. Progressive hypoxia occurs, but normothermia is maintained. To date, 175 ILIs have been performed: 164 for melanoma and 11 for other tumours. Results obtained are similar to those obtained by conventional ILP. Morbidity is low and treatment of frail and elderly patients who would not tolerate ILP is possible. An elective double ILI protocol can be used to obtain the additional benefits of fractionated chemotherapy. The possibility of increasing ILI response rates by using other drugs and drug combinations and by multiple fractionated dosing is being investigated.

MeSH terms

  • Aged
  • Antibiotics, Antineoplastic / administration & dosage
  • Antineoplastic Agents / administration & dosage*
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Agents, Alkylating / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Catheterization, Peripheral
  • Chemotherapy, Cancer, Regional Perfusion*
  • Dactinomycin / administration & dosage
  • Extremities
  • Female
  • Humans
  • Infusions, Intra-Arterial* / methods
  • Male
  • Melanoma / drug therapy*
  • Melphalan / administration & dosage
  • Skin Neoplasms / drug therapy*
  • Tourniquets

Substances

  • Antibiotics, Antineoplastic
  • Antineoplastic Agents
  • Antineoplastic Agents, Alkylating
  • Dactinomycin
  • Melphalan