What is isolated limb infusion ?
Isolated limb infusion is an operation performed under general anaesthesia for treating melanoma and some other cancers that are isolated to an individual limb and where surgery or other treatment methods are not possible. It involves isolation of the circulation within the involved limb with the use of a tourniquet. This allows the use of high concentrations of chemotherapy agents as the drugs are confined within the treated limb.
The operation itself takes approximately 3 hours. Prior to the operation, you will undergo investigations which include blood tests, a CT scan to look for spread of the cancer, and a pre-anaesthetic assessment. In addition, there will be some other specific tests that will be performed to measure the volume of the treated limb to ensure that the right amount of chemotherapy agents are used.
On the day of surgery, tubes will be inserted into the blood vessels in the limb to be treated. These same tubes are used to circulate the blood and to deliver the chemotherapeutic agents once the limb has been isolated with the tourniquet. Following the surgery, you will be under strict bed rest and the treated limb will be monitored for side effects or complications. You will normally be in hospital for 7-10 days.
What are the side effects and complications of ILI ?
The side effects and complications that are commonly encountered include the limb becoming swollen, warm and red. There may also be some peeling of the skin and nails and hairs on the limb may stop growing for a few weeks. Occasionally some patients complain of altered sensation or pins and needles in the limb which improves after a few weeks. Rarely the swelling and inflammation that occurs to the limb is so severe that it may affect the blood supply to the limb. If this occurs, the pressure needs to be relieved with an operation called a fasciotomy. Despite this, the damage can be so severe that it may lead to an amputation of the limb. Another serious side effect is clotting of the veins and arteries within the limb. This may also lead to an amputation. To reduce this risk, you will be given compression stockings to wear and blood thinning injections whilst you are in hospital.
What improvement should I expect to see with ILI ?
It may take a few weeks for the results of the treatment to be obvious. Approximately 70-80% of patients will gain a benefit from ILI. 40% of patients will experience complete resolution of the tumours in their limb. A further 40% of patients will have a partial response with shrinking of the tumours (partial response). 20% of patients will not exhibit a response to the treatment. It is impossible to know which group you will fall into prior to having the treatment.
What follow up will I require ?
Initially you will be reviewed weekly for the first 2 weeks in the dressings clinic to ensure that the limb is healing well. Following this, your dressings can be done either at home by the district nurses or at your local GP practice. We will then aim to review you at 6 weeks and again at 12 weeks if all is going well. If you have been referred from out of region, we will try to minimise your visits by sharing your care with your local hospital doctors.