# Isolated limb perfusion and infusion

Source: https://onco.cc/technologies/isolated-limb-perfusion/  
OnCo record `isolated-limb-perfusion` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Isolating the blood supply of an arm or leg so that chemotherapy doses 15-20 times higher than the body could tolerate can be circulated through it, to save limbs with melanoma or sarcoma that would otherwise be amputated.

## Summary

Creech and Krementz (1958) introduced isolated limb perfusion (ILP): the limb's artery and vein are cannulated and connected to an oxygenated extracorporeal circuit with a tourniquet, and hyperthermic (39-40 °C) melphalan ± TNF-α (Europe) is circulated for 60-90 minutes. Complete response rates are ~50-70% for melanoma in-transit metastases and limb salvage ~80% for locally advanced extremity sarcoma with TNF-melphalan. Isolated limb infusion (ILI, Thompson 1994) is a percutaneous, hypoxic, lower-dose variant with lower morbidity and ~30-40% complete response. Systemic immunotherapy (checkpoint inhibitors, T-VEC) has reduced ILP use in melanoma, but it remains the standard for unresectable extremity sarcoma with TNF in Europe and a salvage option after immunotherapy failure.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-08
- Tags: gap-fill
- Principle: Vascular isolation permits regional drug concentrations far above systemic limits, with hyperthermia and TNF-α (which selectively destroys tumour vasculature) enhancing cytotoxicity and drug penetration.
- Since: 1958
- Strengths: Limb salvage in otherwise unresectable sarcoma; High complete response in melanoma in-transit disease; Minimal systemic toxicity when leak is controlled
- Limitations: Major operation; regional toxicity (Wieberdink grade); TNF-α not approved in the US; Displaced in melanoma by systemic immunotherapy

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Isolated_limb_perfusion
- TNF-melphalan ILP in sarcoma (Ann Surg 2006): https://doi.org/10.1097/01.sla.0000234786.09312.53

## Connected records

- cancers: [Advanced melanoma (unresectable stage III and stage IV)](https://onco.cc/cancers/advanced-melanoma/), [Melanoma](https://onco.cc/cancers/melanoma/), [Sarcomas (soft tissue, bone, GIST)](https://onco.cc/cancers/sarcoma/), [Soft tissue sarcoma of the extremity (localised and advanced)](https://onco.cc/cancers/extremity-soft-tissue-sarcoma/), [Stage III melanoma (after surgery)](https://onco.cc/cancers/stage-iii-melanoma/)
- fronts: [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- technologies: [Hyperthermia](https://onco.cc/technologies/hyperthermia/), [Limb salvage, amputation, and the rehabilitation that follows either](https://onco.cc/technologies/rejuv-recon-limb/), [Limb-salvage surgery and endoprosthetic reconstruction](https://onco.cc/technologies/limb-salvage-surgery/), [Percutaneous hepatic perfusion (chemosaturation)](https://onco.cc/technologies/percutaneous-hepatic-perfusion/)
- drugs: [Dactinomycin (actinomycin D)](https://onco.cc/drugs/dactinomycin/), [Melphalan (including hepatic delivery system)](https://onco.cc/drugs/melphalan/), [Talimogene laherparepvec](https://onco.cc/drugs/talimogene-laherparepvec/), [Tasonermin](https://onco.cc/drugs/tasonermin/)
- terms: [Intraperitoneal (IP) chemotherapy](https://onco.cc/terms/intraperitoneal-chemotherapy/)

---
JSON: https://onco.cc/api/v1/entities/isolated-limb-perfusion.json