Isolated limb infusion

‘Isolated limb infusion’ (ILI) has been developed in the 1990s as a minimally invasive alternative to ‘isolated limb perfusion’ (ILP). Both techniques are designed to treat locally advanced melanoma and sarcoma confined to the limb with locally high dose cytotoxic drugs. After treatment amputation can be avoided in most patients. The most important difference between both techniques is that in ILI the catheters (to create an isolated circuit) are placed percutaneously while this is done with a surgical open procedure in ILP. Although ILI is used in an increasing number of hospitals around the world, literature is still limited. In the current thesis we describe the results of the largest ILI series to date. Results following ILI are comparable to those achieved after ILP without the risk of surgical morbidity and complications. The limb toxicity caused by the cytotoxic drugs is mild to moderate in most patients and short lived. Elderly patients achieve similar results compared to younger patients but with decreased toxicity. Moreover, ILI can be repeated successfully in case of recurrent disease. Local tumor control by ILI in patients with concurrent distant metastases increases the quality of life since an amputation can be avoided. Sometimes, however, the melanoma is so aggressive that amputation of the affected limb has to be performed. Analysis showed that this mutilating procedure can be used as palliation in selected patients. In the second part of the thesis we describe the results of a immunotherapy study to the treatment of cancer with T-cell stimulation. In the future the combination of immunotherapy and ILI could lead to better results in the treatment of patients with melanoma and sarcoma confined to the limb.