"This is significant because originally ILI was performed entirely in an operating room (OR) or as a
hybrid OR-IR procedure,” said Adam DeFoe, the study’s coauthor and an interventional radiologist
with the department of radiology at UNMC. “By performing ILI entirely in the IR suite, there are both
cost and time savings. Additionally, the IR suite generally provides greater scheduling flexibility over
scheduling OR time."
Less Invasive Limb-Sparing
Treatment Shows Promise in
Isolated limb infusion (ILI) is a limb-sparing treatment of in- transit melanoma or sarcoma that can be safely and efficient- ly performed in the interventional radiology (IR) suite,
according to a study published in the March 2017 issue of the
American Journal of Roentgenology.
The study titled “A Single-Center Experience With Isolated
Limb Infusion: An Interventional Oncology Opportunity” is based
on a retrospective review of 11 patients at the University of
Nebraska Medical Center (UNMC), Omaha. It describes in detail
the researchers’ experience with ILI for the treatment of melanoma, squamous cell carcinoma, and sarcoma in-transit metastases
performed entirely in the interventional radiology suite in cooperation with surgical oncologists.
“This is significant because originally ILI was performed en-
tirely in an operating room (OR) or as a hybrid OR-IR procedure,”
said Adam DeFoe, the study’s coauthor and an interventional ra-
diologist with the department of radiology at UNMC. “By per-
forming ILI entirely in the IR suite, there are both cost and time
savings. Additionally, the IR suite generally provides greater
scheduling flexibility over scheduling OR time.”
By using the ILI procedure, the affected extremity’s artery
and vein are accessed percutaneously, thereby avoiding surgical
exposure of the vessels. The extremity is isolated with an exter-
nal tourniquet. Next, high-dose heated chemotherapy is deliv-
Department of Radiology
University of Nebraska Medical
ered via a catheter in a closed system with minimal systemic
leakage. Researchers performed ILI using the technique described by Thompson et al. [ 1] (Fig. 1).
Despite initial appropriate therapy, about 2–10% of patients
with melanoma will have a recurrence in an extremity. This portends poor survival because excision is typically ineffective as a
result of the disseminated nature of lymphatic disease. According
to the American Joint Committee on Cancer, without nodal involvement, these patients are considered as having stage 3A disease with a median survival of 5. 5 years. With nodal involvement,
or stage 3C disease, median survival is down to two years.
Amputation can marginally improve survival, with five-year and
10-year survival rates of 40% and 20%, respectively.
Procedure performed alongside surgical oncologists in interventional radiology suite.
Fig. 1—Simplified diagram of isolated limb infusion circuit. (Illustration by
Heckman AM). With permission from Heckman AM.
Limb Sparing Treatment continues on p. 15