An isolated limb infusion technique: A guide for the perfusionist

Patricia McDermott, D. Scott Lawson, Richard Walczak, Douglas Tyler, Ian R. Shearer

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Isolated limb perfusion with the administration of cytotoxic drugs has been successfully used to treat melanomas of the extremity since it was first introduced in 1958. The use of hyperthermia (40°C) combined with chemotherapy agents, primarily melphalan, has resulted in greater cytotoxicity in laboratory studies, which led to the application of hyperthermia in clinical studies during the 1960s. The effectiveness of this regional technique and the absence of any good systemic therapy made hyperthermic-isolated limb perfusion (HILP) the main treatment for patients with regionally advanced melanoma. HILP involves open surgical dissection and cannulation of the peripheral vessels and is associated with moderate morbidity rates. Blood transfusions, systemic drug leak, infection, and damage to the blood vessels and nerves are all potential hazards associated with this technique. Recently, however, there has been increased interest in an alternative technique termed isolated limb infusion (ILI), which was first reported in 1994 from the Sydney Melanoma Unit in Australia. Based on a few single institution experiences, it was found that there are fewer morbidities associated with HILP than with ILI but no compromise in patient outcomes. ILI is a less invasive procedure involving the use of angiographically placed catheters inserted percutaneously through the femoral vessels that does not require blood donor exposure or use of a heart lung machine. Preliminary data suggest that the resultant local hypoxia and acidosis induced by this procedure potentiates the cytotoxic effects of melphalan. Response rates comparing ILI to HILP seem similar, and both are markedly better than systemic chemotherapy. ILI may be a more desirable option because morbidity is greatly reduced and outcomes appear similar. There is a potential role for the perfusionist in the application of ILI, an evolving area of cancer therapy.

Original languageEnglish (US)
Pages (from-to)396-399
Number of pages4
JournalJournal of Extra-Corporeal Technology
Volume37
Issue number4
StatePublished - Dec 1 2005
Externally publishedYes

Keywords

  • Chemotherapy
  • Hyperthermic-isolated limb perfusion
  • Isolated limb infusion
  • Melanoma
  • Melphalan

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Professions (miscellaneous)
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    McDermott, P., Lawson, D. S., Walczak, R., Tyler, D., & Shearer, I. R. (2005). An isolated limb infusion technique: A guide for the perfusionist. Journal of Extra-Corporeal Technology, 37(4), 396-399.