Chemotherapy into a limb

Isolated limb perfusion (ILP) is a way of giving anti-cancer drugs directly into a limb. It can be used to control melanoma that has come back in a limb. You can only have IPL if the melanoma has not spread elsewhere.

There are two ways of giving chemotherapy into a limb: isolated limb perfusion and isolated limb infusion. These treatments are only carried out in some specialist UK centres.

ILP is given under general anaesthetic and you will stay in hospital for 7–10 days. The procedure is done by a surgeon who specialises in operations involving blood vessels (a vascular surgeon).

Your surgeon will use a tourniquet and disconnect the blood flow from your limb to the rest of your body. Anti-cancer drugs are then pumped through the limb before the surgeon removes the tourniquet and reconnects the blood supply to the rest of the body.

Isolated limb infusion is a simpler procedure – the blood from the limb doesn’t need to go through a pump.

After your procedure a nurse will closely monitor your limb and make sure your blood flow is normal.

Isolated limb perfusion

You may be given chemotherapy directly into a limb (leg or arm) to treat clusters of melanomas that have come back in the same limb. These clusters of melanomas are called satellite lesions or in-transit lesions. This is known as regional treatment. This treatment is only given if the melanoma hasn’t spread anywhere else in the body.

There are two ways of giving chemotherapy into a limb: isolated limb perfusion (ILP) and isolated limb infusion. These treatments are only carried out in some specialist centres in the UK. You may have to travel to another hospital if your specialist advises you to have this treatment.

The drugs are given directly into the affected limb, which is isolated using a tight band (tourniquet). This prevents the treatment from going to other areas of your body. This means you’re unlikely to get the common side effects of having chemotherapy, such as feeling sick, being at more risk of getting an infection, and losing the hair from your head.

During ILP, the surgeon temporarily disconnects the blood flow between your affected limb and the rest of your body. The blood is circulated through an external pump and back into your limb. The chemotherapy drugs are given into the blood that circulates through your limb.


Isolated limb infusion

This is similar to isolated limb perfusion and may be used as an alternative to it. With this treatment, the blood from the limb doesn’t need to go through a pump.

This makes it a simpler procedure to carry out than isolated limb perfusion. Your doctors will be able to tell you more about isolated limb infusion if this is a suitable treatment for you.


When ILP can be given

Sometimes melanoma comes back (recurs) in the skin, very close to where the original melanoma was. This is called a local recurrence. If you have a recurrence, it’s usually treated with an operation to remove it. Surgery can be used even if you have more than one local recurrence.

Sometimes clusters of melanomas come back in the same limb, but further away from the original melanoma. Doctors call these satellite lesions or in transit metastases. Because there are lots of them, it can be difficult to remove them all with surgery. In this situation, a specialist may advise that you have ILP.


How ILP is given

ILP is given under a general anaesthetic and usually involves staying in hospital for 7–10 days. The procedure is carried out by a surgeon who specialises in operations involving blood vessels (vascular surgeon) and who has experience in ILP.

Below is the usual procedure:

  • First the surgeon makes a small cut in your lower abdomen, groin or thigh if the melanoma is in your leg, or in your armpit if the melanoma is in your arm.
  • The surgeon temporarily disconnects the blood flow (circulation) between the affected limb and the rest of your body.
  • Fine tubes are placed into your blood vessels. This is to transfer the blood flow from your limb to a pump. Your blood is circulated through the pump, and then goes back into your limb.
  • A tourniquet is then applied to the top of your limb. This is to make sure the blood and circulating drugs stay in your limb.
  • Oxygen is added to the blood going to your limb by a machine called an oxygenator. This is because your limb still needs to get oxygen during the treatment. After the treatment, your limb will get oxygen in the usual way from the blood flowing through your lungs.
  • The blood to your limb may also be heated, as some research shows that this improves the results of the treatment.
  • High doses of anti-cancer drugs are given into the blood circulating through the pump, which then go into your limb. The drugs circulate in your limb for about an hour.
  • After the procedure is finished, the blood flow from your limb is reconnected to the rest of your body and the tourniquet is removed. The blood supply to your limb goes back to normal.

Because the blood flow to your limb is disconnected from the rest of your circulation during treatment, the drugs won’t travel anywhere else in your body.


The drugs used

A chemotherapy drug called melphalan is usually used. It can be given on its own, or sometimes with an immunotherapy drug called tumour necrosis factor (TNF). Another chemotherapy drug that may be used is actinomycin D.


After the operation

The nurses and doctors will monitor you closely. You’ll have to rest and raise (elevate) your limb. This improves the blood circulation and allows time for the tissues in your limb to heal. You may need to do this for several weeks after you go home too. Your surgeon will advise you on this. You will also be monitored after the operation to make sure you don’t have any complications. If anything does happen, it will usually be picked up early.


Blood clot

The nurses will take the pulse in your limb regularly to make sure the blood flow is good. There’s a small risk of developing a blood clot, which would cause symptoms such as pain, redness and swelling in the limb, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you have any of these symptoms. Most clots can be treated with drugs that thin the blood. Your doctor or nurse can tell you more about this.


Damage to the blood vessels

There may be a risk of damage to the main blood vessels supplying the limb. Usually when this happens, the surgeon recognises it during the procedure and can repair any damage there and then.

If you have any questions, you can ask your doctor or nurse at the hospital where you’re having your treatment.

Back to Isolated limb perfusion