Isolated limb infusion with cytotoxic agents: a simple alternative to isolated limb perfusion.
Isolated limb perfusion (ILP) with cytotoxic agents is an effective but complex procedure. Isolated limb infusion (ILI) has been developed as a simpler alternative. Catheters are inserted percutaneously into the axial artery and vein of the affected limb and a pneumatic tourniquet is inflated proximally. Cytotoxic agents are then infused through the arterial catheter and circulated with a syringe for 15 to 20 minutes. Progressive hypoxia occurs, but normothermia is maintained. To date, 175 ILIs have been performed: 164 for melanoma and 11 for other tumours. Results obtained are similar to those obtained by conventional ILP. Morbidity is low and treatment of frail and elderly patients who would not tolerate ILP is possible. An elective double ILI protocol can be used to obtain the additional benefits of fractionated chemotherapy. The possibility of increasing ILI response rates by using other drugs and drug combinations and by multiple fractionated dosing is being investigated.
Thompson
J F
JF
Department of Surgical Oncology, Royal Prince Alfred Hospital, University of Sydney, Australia. john@mel.rpa.cs.nsw.gov.au
Kam
P C
PC
Waugh
R C
RC
Harman
C R
CR
D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002406:Catheterization, Peripheral; D010478:Chemotherapy, Cancer, Regional Perfusion; D003609:Dactinomycin / Q000008:administration & dosage; D005121:Extremities; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods; D008297:Male; D008545:Melanoma / Q000188:drug therapy*; D008558:Melphalan / Q000008:administration & dosage; D012878:Skin Neoplasms / Q000188:drug therapy*; D014111:Tourniquets
D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D018906:Antineoplastic Agents, Alkylating; D003609:Dactinomycin; D008558:Melphalan