Having a chemotherapy into a limb

Chemotherapy can be given directly into a limb. This 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 2 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. 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 is not used with ILI.

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

Having 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 are 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 2 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 is 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 has not 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 way to have ILP is:

  • You have a general anaesthetic.
  • If the cancer is in the leg, the surgeon makes a small cut in the thigh, or occasionally in the lower abdomen or groin. If the cancer is in the arm, the surgeon makes a small cut in the armpit or arm.
  • The surgeon temporarily disconnects the blood-flow (circulation) between the affected limb and the rest of the body. They then put 2 small tubes (catheters) into the main blood vessels in the limb. The first tube allows the blood to flow from the limb to a pump. Your blood is circulated through the pump, and then goes back into the limb through the second tube.
  • A tourniquet is applied to the top of the limb. This is to stop the chemotherapy drugs circulating into the rest of the body. Oxygen is added to the blood going to the limb. This is done by a machine called an oxygenator. This is because the limb still needs oxygen during the treatment. After the treatment, the limb will get oxygen in the usual way – from the blood flowing through the lungs.
  • The blood to the limb may also be heated, as some research shows this improves the results of the treatment.
  • High doses of anti-cancer drugs are given into the blood that is circulating through the pump into the limb. The drugs circulate in the limb for up to 90 minutes.
  • Once the treatment is finished, the drugs are flushed out of the limb using salt water (saline).
  • The surgeon reconnects the blood-flow from the limb to the rest of your body. They remove the tourniquet, and the blood-flow goes back to normal. They then remove the catheters and seal the blood vessels to prevent any bleeding.

Isolated limb perfusion
Isolated limb perfusion

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Because the blood-flow to the limb is disconnected from the rest of your circulation during treatment, the drugs will not 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). Immunotherapy is the name given to cancer treatments that use the body’s immune system to attack cancer cells.

Another chemotherapy drug 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 does not circulate through a pump and no oxygen is added. Because of this, the length of time that the tourniquet can be on for is shorter. This reduces the amount of time that chemotherapy can circulate in the limb. The usual process for having ILI is: 

  • The tubes (catheters) used are smaller than for ILP. They are put in through a small cut made in the groin or armpit. This happens in the x-ray department. You are usually awake for this, but the doctor uses a local anaesthetic to numb the area. For ILI treatment in the leg, they sometimes put the catheters into the groin on the opposite side of the body to the leg that is being treated.
  • After the catheters are in place, you are taken to the operating theatre and given a general anaesthetic.
  • A tourniquet is applied to the limb. This is to stop the chemotherapy drugs circulating into the rest of the body.
  • High doses of anti-cancer drugs are given into the blood supply in the limb. The drugs circulate for about 20 to 25 minutes. Tumour necrosis factor (TNF) is not used with ILI.
  • The blood going back into the limb may be heated.
  • Once the treatment is finished, the drugs are flushed out of the limb using saline (salt water).
  • The surgeon removes the tourniquet and reconnects the blood-flow from the limb to the rest of the body. They then remove the catheters and seal the blood vessels to prevent any bleeding.
Isolated limb infusion
Isolated limb infusion

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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 will have to rest and raise (elevate) your limb. This improves the blood circulation and allows time for the tissues in your limb to heal. Your surgeon will advise you on how long you need to do this for. You will also be monitored after the operation to make sure you do not 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 is a small risk of developing a blood clot. This would cause symptoms such as:

  • pain
  • redness and swelling in the limb
  • breathlessness and chest pain.

Blood clots can be very serious, so it is 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.

How chemotherapy is given

Chemotherapy can be given in different ways depending on the type of cancer you have and your treatment plan.

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 is put into the arm to give chemotherapy and other medicines.

Lumbar punctures

A lumbar puncture involves inserting a hollow needle between 2 of the spinal bones. This may be used to give chemotherapy.