What is Isolated Limb Perfusion?
Isolated Limb Perfusion (ILP) is a surgical procedure in which chemotherapy is delivered into a limb (arm or leg) affected by a tumour. This is a type of “regional chemotherapy”, where very high doses of chemotherapy can be administered directly to the tumour. By isolating the limb from the rest of the body’s blood supply, ILP treats the tumour and avoids many of the toxic side effects of chemotherapy because the drugs are only distributed to the limb.
ILP is performed with 2 chemotherapy drugs – melphalan and tumour necrosis factor-alpha. Peter Mac’s lead surgeon in ILP, Dr Hayden Snow, is the only clinician in Australia accredited to administer tumour necrosis factor-alpha.
ILP using tumour necrosis factor-alpha has become an important technique in the management of patients with advanced soft-tissue tumours of the limbs. It is proven to be effective at avoiding amputation in a large number of patients in whom other limb-salvage treatments have either failed or are not technically possible.
Who can get ILP?
ILP can be used to treat several different tumour types, the most common being melanoma and sarcoma, but can also be used in some other types of skin and soft-tissue tumours. It is usually recommended for patients where standard surgery to remove the tumour is not possible.
In sarcoma (soft-tissue cancer), some patients have tumours that are only removable by amputation. ILP is used as an alternative to amputation and is proven to be successful in preventing amputation in many patients.
Another form of regional chemotherapy, Isolated Limb Infusion (ILI), can also be performed at Peter Mac. Whilst ILI and ILP are probably equally effective for treating inoperable melanoma, ILP is superior for treating sarcoma and other soft tissue tumours.
The procedure
ILP is a surgical procedure performed under general anaesthesia. An incision is made in the arm or leg to find the main blood vessels. The surgeon then places large tubes into the artery and vein, and a tourniquet on the top of the limb – this temporarily disconnects the blood supply of the limb from the rest of the body and prevents any chemotherapy leaking back into the body. The tubes are connected to a machine which adds oxygen and chemotherapy to the patient’s own blood and pumps it into the limb.
The blood and chemotherapy are pumped around the limb for about an hour and then washed out. The tubes are removed and the surgeon stitches up the artery and vein. The blood flow to the limb is then returned to the rest of the body and the skin is stitched closed.
After the procedure, the patient goes to the ward and will usually stay in hospital for about 5 days.
What are the side-effects and risks?
As with all surgical procedures, ILP has some side-effects and risks, most of which are minor and well-tolerated. Most people after ILP will have some pain, swelling and redness in the limb which often lasts for 6-8 weeks after the procedure. Simple pain-killers like paracetamol are adequate treatments in most people.
A minority of patients get more severe symptoms after ILP - these may require a longer stay in hospital but usually settle without needing any specific treatment. Very severe side-effects, whilst possible, are thankfully very rare.
Contact
If you are a clinician with a patient for whom ILP may be suitable or you are a patient interested in enquiring about ILP, we would be delighted to be contacted for advice or an opinion.
Peter Mac switchboard – (+61 3) 8559 5000 and ask for the Sarcoma Nurse Consultant
