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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.
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.
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.
The first antibiotic used as an anticancer drug (1954) and still the core of chemotherapy for Wilms tumour, rhabdomyosarcoma and gestational trophoblastic disease.
The myeloma chemotherapy that is also the standard high-dose conditioning before autologous transplant, and, delivered directly into the liver's blood supply or the eye, treats uveal melanoma metastases and retinoblastoma.
Beromun is a recombinant form of the immune protein TNF-alpha, pumped with the chemotherapy melphalan through the isolated blood supply of an arm or leg to shrink soft-tissue sarcomas so that the limb can be saved rather than amputated.
Query for this technology: (TITLE:"Isolated limb perfusion and infusion" OR ABSTRACT:"Isolated limb perfusion and infusion") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Isolated limb perfusion and infusion, not a curated reading list.
Shares Tasonermin, Limb salvage, amputation, and the rehabilitation that follows either, Limb-salvage surgery and endoprosthetic reconstruction, Sarcomas (soft tissue, bone, GIST).
Shares Percutaneous hepatic perfusion (chemosaturation), Melphalan (including hepatic delivery system), Melanoma.
Shares Talimogene laherparepvec, Advanced melanoma (unresectable stage III and stage IV), Melanoma.
Shares Talimogene laherparepvec, Advanced melanoma (unresectable stage III and stage IV), Melanoma.
Shares Stage III melanoma (after surgery), Advanced melanoma (unresectable stage III and stage IV), Melanoma.
Shares Intraperitoneal (IP) chemotherapy, Percutaneous hepatic perfusion (chemosaturation), Melanoma.
Shares Talimogene laherparepvec, Advanced melanoma (unresectable stage III and stage IV), Melanoma.
Shares Talimogene laherparepvec, Melanoma.