Isolated Limb Infusion for Recurrent and Locally Metastatic Limb Melanoma
Recurrent and metastatic melanoma confined to a limb is a frequently encountered clinical problem in patients with initial primary limb melanoma. Regional chemotherapy using isolated limb perfusion (ILP) provides effective treatment, but is invasive, complex, and costly. Isolated limb infusion (ILI) chemotherapy is a simple, minimally invasive, and effective alternative to ILP.
ILI involves drug administration into a limb via percutaneously inserted catheters after vascular isolation of the limb with a tourniquet. The infused drugs, normally melphalan and actinomycin D, are circulated for 30 minutes via a simple extracorporeal circuit incorporating a heater to produce mild hyperthermia of the limb, but with no oxygenation.
Limb tumor remission rates following ILI are similar to those achieved by conventional ILP. ILI is well tolerated and, in contrast to ILP, elderly patients and those with major medical comorbidities and peripheral vascular disease can be treated with satisfactory results.
The development of effective systemic treatment options for patients with melanoma in the past decade has provided new melanoma therapy options. However, the response and control rates of ILI are still superior to those achieved following systemic therapy. Nevertheless, there is great potential value in combining regionally applied ILI with systemically administered agents to achieve an optimal and sustained response, and clinical trials of combined regional and systemic therapies are in progress.
KeywordsMelanoma Metastasis Extremity Unresectable Isolated limb infusion Melphalan Actinomycin D
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