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What is isolated limb infusion (ILI)?
Isolated limb infusion is a form of treatment which uses chemotherapy to treat cancer which is confined to a limb.
When is ILI used?
ILI is used in patients who have melanoma, or other cancer, which is confined to a limb, and which is not suitable for treatment with surgery or other methods. This is usually because the cancer has spread widely or deeply in the limb, or because it is spreading quickly.
What does ILI involve?
Isolated limb infusion involves an operation. The first part of the procedure is to isolate the affected arm or limb from the rest of the body using a tourniquet which blocks the normal blood supply to the limb. Secondly, drugs can be given in a high dose without affecting the rest of the body because the tourniquet keeps the chemotherapy drugs confined to the limb. This means that the anti-cancer drugs can be focused where they are needed – in the affected limb.
On the morning of the operation you will be seen by the team who will do the operation, and the affected leg or arm will be marked to show the position of the tourniquet. The lumps (called ‘satellites’ or ‘in transit metastases’) on your limb will be measured and recorded if this has not been done already. The procedure will be explained again, although you will already have received a detailed explanation about ILI in the clinic. You will be asked to sign the consent form. Later in the morning you will be taken to the X-ray department where some catheters (tubes) will be inserted through the skin of the groin of the unaffected limb. This is done using local anaesthetic to numb the skin. Pumps are then connected to the tubes to keep them open and stop blood from clotting in them. On your return to the ward a special blanket will be applied to your limb and lower body to keep it warm.
During the late morning or early afternoon you will be taken to the operating theatre and be given a general anaesthetic. Once asleep your blood will be thinned with a drug that stops it from clotting, and the tourniquet will be placed around the affected limb to cut off its blood supply; this prevents the chemotherapy leaking into the rest of the body. The chemotherapy is then injected into the limb over about 5 minutes. It is then circulated around the limb for about 20-25 minutes. During this time the blood circulating through the limb is warmed by passing it through a heating coil. Warming the blood makes the chemotherapy more effective. When the procedure is completed the limb is flushed with saline (salty water) to remove any residual drugs, the tourniquet is removed, and the normal circulation to the limb is therefore restored. The blood thinning is reversed, and the catheters (tubes) are removed. A small procedure is then performed to seal off the big blood vessels in the groin to prevent any bleeding. In general you will be in the operating theatre for about 90-120 minutes.
On your return to the ward you will have to remain in bed for several days whilst the limb is rested, and whilst we check that it is recovering from the treatment. This will involve measuring the size of the limb, how soft or firm it is, its colour, and checking the pulses in the limb. If the limb is painful you must tell the ward staff – if the pain is increasing it is important that the doctors check your limb. During this time your blood will be thinned using daily injections under the skin, and you will wear a stocking/s to prevent a clot forming in your calf, called a deep vein thrombosis (DVT). You will normally be in hospital for 7-10 days.
Investigations required prior to Isolated Limb Infusion.
On your first visit we check that you are suitable for ILI and explain the procedure in some detail. Prior to having the procedure carried out a number of investigations are needed. These include:
- A vascular assessment. This test shows us how well the blood vessels in your limb work
- A CT scan. This allows us to check if the cancer is in any other parts of the body. This may have been done before you were referred to us.
- Blood tests. These check that the organs inside the body are working correctly
- A pre-anaesthetic assessment. This enables us to check that you are fit to have a general anaesthetic.
We will try to arrange for all or some of these tests to be done on the same day to avoid you having to visit the hospital often. This will normally be on your second or third visit, when we will also discuss the procedure with you again at that visit to answer any questions you may have.
Are there any side effects?
Shortly after the ILI it is normal for all or some of the following effects to occur because some normal tissues are affected at the same time as the cancer cells are destroyed.
- The limb will become swollen, warm and red.
- Sometimes mild ‘pins and needles’ sensations are experienced for the first few days and very occasionally discomfort in the limb due to inflammation of nerves (neuritis) for a few weeks.
- The skin may peel a little.
- Nails and hair on the treated limb may stop growing for a few weeks.
Occasionally more dramatic inflammation in the limb occurs, which usually settles after about 6 weeks. This is more likely if large doses of chemotherapy and high limb temperatures are used, for instance if there is a lot of melanoma in the limb. If this occurs anti – inflammatory drugs are prescribed and an operation to release the pressure in the limb may occasionally be necessary to prevent further damage to muscles or nerves in the leg. Sometimes this inflammation can lead to serious damage to the limb, and this could lead to amputation. This is the main reason why we normally only use ILI or when other methods have failed. The potentially serious risks of both ILI are less when the team treating you are practised and experienced in the techniques.
Another serious but rare side effect is thrombosis (clotting) in the veins or arteries of the limb. This too may lead to loss of the limb. To reduce the risk of thrombosis you will be given anticoagulants (anti-clotting drugs) and you will need to remain in hospital to rest the limb.
Following the ILI
Following the ILI you will be required to stay on strict bed rest for 6 days. Initially on your return to the ward your limb will be checked frequently, even through the night. Some patients experience some mild nausea in the early post-operative period. This can be readily controlled with drugs.
Information about Coltishall Ward
- You will be cared for on Coltishall Ward. This ward is situated in West Wing on level 2
- Visiting times are 2-4pm and 6-8pm and a maximum of 2 visitors per bed is advised. It is not usually suitable for young children to visit but please ask the Sister of nurse in charge.
- There is a phone by the bed but you will need to purchase credit to accept incoming as well as outgoing calls.
- Meals are served at 7:30am, 12.30pm, and 5:30pm approximately. You will have a choice of a variety of dishes when you fill out your menu cards
What to bring
- Beside your bed will be a locker for you to store your personal belongings.
- Bring a towel, night clothes, toiletries, and shaving kit.
- A small amount of money is useful for newspapers.
- Any medicines or tablets which you normally take
- Please do not bring large amounts of cash or valuables
- Books and magazines
Following the ILI at home
You will generally be allowed to go home between 5-10 days. You will have spent the last few days lying in bed and therefore this may leave you feeling weak and tired. Most people find that they need more help at home than they expected. We therefore advise that you arrange for someone to look after you or that you stay with a friend or relative on your discharge. Please let us know immediately if you are not able to arrange this.
How long before I will see any improvement?
Approximately 40% of people who have ILI experience a complete disappearance in their tumours. Good control (or a partial response) is experienced in another 30-40% of cases. It may be many weeks before you will see any benefit from the treatment. The treatment can be repeated if required.
How frequently will I be followed up?
We will review you at 2 weeks and 6 weeks following treatment. If all is going well we would see you again at 10 – 12 weeks. If you have been referred from outside East Anglia we will try to minimise your visits by sharing your care with the doctors looking after you locally.