Because of the obvious morbidity associated with amputation
and the limited effectiveness of systemic chemotherapy, isolated
limb perfusion (ILP) was developed and introduced in 1957.
The ILP procedure requires the affected extremity’s artery
and vein to be accessed via surgical incision and openly cannulated to deliver high-dose heated chemotherapy. Although it is
effective, the study indicates that ILP requires surgical exposure
of the vessels and 4–6 hours of operating room time. ILP also
requires a blood transfusion for the patient because of the creation of an extracorporeal perfusion circuit.
Although ILP has a superior initial treatment response compared with ILI, the results are not durable. The median time to
progression after ILP ranges from 9–24 months. More than one-half of these patients will have recurrent disease in the first year,
with an overall five-year survival rate of 30–40%. ILI, in contrast,
has a reported five-year survival rate of 50%, with median survival rate of 58 months. For those without a complete response,
resection of residual disease after ILI is equivalent to a complete
response with respect to disease-free survival, thus further improving treatment outcomes.
DeFoe reports that ILI has replaced ILP at UNMC. He added,
“Due to the minimally invasive nature of ILI, we believe other
institutions will follow suit, especially now that the response
rates of ILI are similar to ILP.”
Repeating ILI may be especially valuable for those with high-
er tumor burden, because others have shown less favorable ini-
tial responses to ILI with higher tumor burden and increased
Nevertheless, ILI is not without risk. Potential complications
include those related to percutaneous access and chemotherapy-
Limb Sparing Treatment continued from p. 8
"Despite the encouraging data, it should be
noted that no regional treatment of metastatic
melanoma, including amputation, has been
shown to prolong overall survival,” said
DeFoe. “The need for further study, technical
refinement, and outcome stratification is clear."
hemorrhage, pseudoaneurysm, infection, limb toxicity, and compartment syndrome. The most common adverse effects are
transient erythema and skin edema with localized inflammation.
Overall, ILI is generally well tolerated. The survey data reveal no
decrease in quality of life from baseline to three months after ILI.
Higher response rates were seen in younger patients, with
the odds of a good response decreasing by three with each year.
This may provide a partial explanation for ILP’s superior response rates. The average age of patients undergoing ILI is older
than that of patients undergoing ILP. These outcomes are based
on the increased risks associated with ILP and subsequent patient exclusion criteria.
“Despite the encouraging data, it should be noted that no regional treatment of metastatic melanoma, including amputation,
has been shown to prolong overall survival,” said DeFoe. “The
need for further study, technical refinement, and outcome stratification is clear.”n
1. Thompson JF, Kam PC, Waugh RC, Harman CR. Isolated limb infusion with
cytotoxic agents: a simple alternative to isolated limb perfusion. Semin Surg
Oncol 1998; 14:238–247
observation and to some extent by exploring. AI may also be
able to question certain aspects of data that can lead to certain discoveries. It is not clear whether AI has the inherent
wisdom to interpret the unique events of serendipity that are
almost always a component of major discoveries. Most importantly, AI will not likely have the human-like qualities that are
often so critical in discoveries, such as intuition, curiosity,
abstract thought, sagacity, motivation, passion, intensity, and
persistence much like Wilhelm Roentgen had in 1895.
So, it is very possible that some, or much, of what we do today
as radiologists could be augmented or replaced by AI. However,
through the human endeavors of innovation and discovery we
can engage AI and discover new approaches and new solutions
that will improve patient care and keep radiology (and radiolo-
President's Message continued from p. 2
It is very possible that some of what we do
today as radiologists could be augmented or
replaced by AI. However, through the human
endeavors of innovation and discovery we can
engage AI and discover new approaches and
new solutions that will improve patient care.
gists) in the forefront of optimizing the care of our patients. The
American Roentgen Ray Society is committed to engaging this
new and exciting technology and will continue to foster new discoveries through our journal, our annual meeting, and support of
radiology research through the Roentgen Fund.n