Chemotherapy into a limb

Chemotherapy can be given directly into a limb. It is called regional chemotherapy. It can be used to control a melanoma or soft tissue sarcoma that has come back in a limb, but has not spread elsewhere.

There are two ways of giving chemotherapy into a limb:

  • isolated limb perfusion (ILP)
  • isolated limb infusion (ILI).

These treatments are only carried out in some specialist UK centres.

ILP and ILI are given under general anaesthetic and you will stay in hospital for 3 to 7 days.

A surgeon disconnects the blood flow to your limb from the rest of your body. They give anti-cancer drugs into the blood that circulates through the limb. A tourniquet prevents the drugs from going into the rest of the body. The drugs are flushed out of the limb before the blood supply is reconnected.

With ILP the blood circulates through a pump that adds oxygen to the blood. A pump isn’t used with ILI.

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

Chemotherapy into a limb

Chemotherapy can be given directly into a limb (leg or arm) to help control cancer that has come back in one area. This is also called regional chemotherapy.

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

Regional chemotherapy is only done once.

There are two ways of giving chemotherapy into a limb:

  • isolated limb perfusion (ILP)
  • isolated limb infusion (ILI).

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.


When regional chemotherapy can be given

Chemotherapy can be given directly into a limb to treat melanoma or sarcoma.


Regional chemotherapy for melanoma

Melanoma is a type of skin cancer. It develops from cells in the skin called melanocytes. These cells give our skin its colour.

Most melanomas can be successfully treated with surgery. 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. You can have surgery 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 either ILP or ILI.

These treatments are only given if the melanoma hasn’t spread anywhere else in the body.

Regional chemotherapy for sarcoma

Soft tissue sarcomas are cancers that develop from cells in the soft, supporting tissues of the body, for example in fat, muscle, nerves or blood vessels.

Sarcoma in a limb can often be treated successfully using surgery and radiotherapy. You may also have chemotherapy . Sometimes the sarcoma is too large to be removed with an operation (locally advanced) or it may come back in the same area after treatment (local recurrence). In these situations you can often have further treatment to help control the cancer. One of the treatment options is regional chemotherapy with either ILP or ILI.


Isolated limb perfusion (ILP)

ILP is a surgical procedure given under a general anaesthetic. It usually involves staying in hospital for 3 to 7 days.

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

The usual procedure is:

  • You will have a general anaesthetic.
  • If the cancer is in your leg the surgeon will make a small cut in your thigh, or occasionally in your lower abdomen or groin. If the cancer is in your arm the cut is made in your armpit or arm.
  • The surgeon temporarily disconnects the blood flow (circulation) between the affected limb and the rest of your body.
  • They put two small tubes (catheters) into the main blood vessels in the limb. The first tube allows the blood to flow from your limb to a pump. Your blood is circulated through the pump, and then goes back into your limb through the second tube.
  • A tourniquet is 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 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 into your limb. The drugs circulate in your limb for up to 90 minutes.
  • The drugs are then flushed out of your limb using salt water (saline).
  • After the procedure is finished, the surgeon reconnects the blood flow from your limb to the rest of your body. The tourniquet is removed and the blood supply goes back to normal. They then remove the catheters and seal the blood vessels to prevent any bleeding.

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.


Isolated limb perfusion
Isolated limb perfusion

View a large version

Read a description of this image


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). Immunotherapy is the name given to cancer treatments that use the body’s immune system to attack cancer cells.

Another chemotherapy drug that you may have is dactinomycin.


Isolated limb infusion (ILI)

This is a similar treatment to isolated limb perfusion and may sometimes be used instead. With ILI the blood doesn’t circulate through a pump and no oxygen is added. Because of this, the length of time that the tourniquet can be applied is shorter, which reduces the amount of time that chemotherapy can circulate in the limb.

  • The tubes (catheters) used are smaller than for ILP. They will be put in while you are in the x-ray department through a small cut made in the groin or armpit. You will usually be awake for this but the doctor will use a local anaesthetic to numb the area. For ILI treatment in the leg, the catheters are sometimes put into the groin on the opposite side of the body to the leg that is being treated.
  • After the catheters are in place you will be taken to the operating theatre and given a general anaesthetic.
  • A tourniquet will be applied to the limb to prevent the chemotherapy drugs circulating into the rest of your body.
  • High doses of anti-cancer drugs are then injected into the blood and circulate in your limb for about 20 to 25 minutes. TNF is not used with ILI.
  • The blood circulating through your limb may also be heated.
  • Once the treatment is finished the drugs are flushed out of your limb using saline.
  • The tourniquet will be removed and the blood flow from your limb is reconnected to the rest of your body. The catheters are then removed.

Your doctors will be able to tell you more about isolated limb infusion if this is a suitable treatment for you.


After the procedure

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. 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 clots

The nurses will check 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
  • 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

During regional chemotherapy there is a very small risk of damage to the main blood vessels supplying the limb. If this happens, the surgeon will recognise it during the procedure and will repair any damage straight away.

Your surgeon will discuss the risks of regional chemotherapy with you.

Back to Being treated with chemotherapy

Where can I have chemotherapy?

Usually chemotherapy is given in a chemotherapy day unit. Some may people stay in hospital, or have treatment at home.

Central lines

A central line is a long, thin hollow tube. It is inserted into a vein in your chest to give chemotherapy and other drugs.

Implantable ports

An implantable port is a tube with a rubber disc at the end. It is inserted into a vein to give chemotherapy or other medicines.

PICC lines

A PICC line is a long, thin, flexible tube known as a catheter. It’s put into the arm to give chemotherapy and other medicines.