{"entity":{"id":"isolated-limb-perfusion","kind":"technology","name":"Isolated limb perfusion and infusion","aka":[],"tldr":"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.","status":"established","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Isolated_limb_perfusion","links":[{"label":"TNF-melphalan ILP in sarcoma (Ann Surg 2006)","url":"https://doi.org/10.1097/01.sla.0000234786.09312.53"}],"tags":["gap-fill"],"related":[],"cancers":["melanoma","sarcoma","extremity-soft-tissue-sarcoma"],"sections":["surgery"],"technologies":["hyperthermia","limb-salvage-surgery","percutaneous-hepatic-perfusion"],"targets":[],"drugs":["melphalan","dactinomycin","talimogene-laherparepvec"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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"],"since":1958},"route":"/technologies/isolated-limb-perfusion/","neighbours":{"cancer":[{"id":"advanced-melanoma","kind":"cancer","name":"Advanced melanoma (unresectable stage III and stage IV)","route":"/cancers/advanced-melanoma/"},{"id":"melanoma","kind":"cancer","name":"Melanoma","route":"/cancers/melanoma/"},{"id":"sarcoma","kind":"cancer","name":"Sarcomas (soft tissue, bone, GIST)","route":"/cancers/sarcoma/"},{"id":"extremity-soft-tissue-sarcoma","kind":"cancer","name":"Soft tissue sarcoma of the extremity (localised and advanced)","route":"/cancers/extremity-soft-tissue-sarcoma/"},{"id":"stage-iii-melanoma","kind":"cancer","name":"Stage III melanoma (after surgery)","route":"/cancers/stage-iii-melanoma/"}],"section":[{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"technology":[{"id":"hyperthermia","kind":"technology","name":"Hyperthermia","route":"/technologies/hyperthermia/"},{"id":"rejuv-recon-limb","kind":"technology","name":"Limb salvage, amputation, and the rehabilitation that follows either","route":"/technologies/rejuv-recon-limb/"},{"id":"limb-salvage-surgery","kind":"technology","name":"Limb-salvage surgery and endoprosthetic reconstruction","route":"/technologies/limb-salvage-surgery/"},{"id":"percutaneous-hepatic-perfusion","kind":"technology","name":"Percutaneous hepatic perfusion (chemosaturation)","route":"/technologies/percutaneous-hepatic-perfusion/"}],"drug":[{"id":"dactinomycin","kind":"drug","name":"Dactinomycin (actinomycin D)","route":"/drugs/dactinomycin/"},{"id":"melphalan","kind":"drug","name":"Melphalan (including hepatic delivery system)","route":"/drugs/melphalan/"},{"id":"talimogene-laherparepvec","kind":"drug","name":"Talimogene laherparepvec","route":"/drugs/talimogene-laherparepvec/"},{"id":"tasonermin","kind":"drug","name":"Tasonermin","route":"/drugs/tasonermin/"}],"term":[{"id":"intraperitoneal-chemotherapy","kind":"term","name":"Intraperitoneal (IP) chemotherapy","route":"/terms/intraperitoneal-chemotherapy/"}]}}