Find out about how and when you have chemotherapy into an arm or leg. This is called regional chemotherapy.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. Regional chemotherapy is a way of having chemotherapy just into one arm or leg, without the drugs circulating through the rest of your body.
A surgeon usually gives you regional chemotherapy and you have a general anaesthetic.
When you have it
Doctors only use regional chemotherapy if your melanoma skin cancer has come back in an arm of leg very near to where it started. This is called a local recurrence.
Types of regional chemotherapy
There are 2 types of regional chemotherapy for melanoma. They are:
- isolated limb infusion
- isolated limb perfusion
Isolated limb infusion (ILI)
You have this treatment under general anaesthetic. The surgeon puts tubes into the blood vessels that carry blood in and out of the limb. This disconnects the blood supply to the limb from the rest of the blood circulating around the body. The surgeon then connects the tubes to a pump and a machine that puts chemotherapy into the blood.
The blood may also be heated, because some studies show better results from warming the blood a degree or two. This may be because the blood vessels expand at a higher temperature to let more blood into the body tissues.
Once the machine is connected you can have a high dose of chemotherapy or biological therapy into the blood. This circulates through that arm or leg without having any effect on the rest of the body. After a short time, the surgeon reconnects the blood vessels and your blood circulation goes back to normal.
Isolated limb perfusion (ILP)
You have this treatment under general anaesthetic. It takes about an hour. The surgeon then reconnects the blood vessels and your blood circulation goes back to normal.
Isolated limb perfusion is very similar to isolated limb infusion. But the machine also gives oxygen as well as chemotherapy or biological therapy into the blood going into the limb. This means you can have the treatment for a longer time.
You don't have the usual side effects of chemotherapy with this type of treatment. The drugs don't circulate through the rest of your body in high enough amounts to make you lose your hair or feel sick.
Your shoulder or groin will be sore where the tubes go in and out. Your nurse will give you painkillers as you need them. If the drugs don't control your pain, tell your doctor or nurse as soon as possible. You may need a higher dose, or a different type of painkiller.
Redness and swelling
You will also have some redness and swelling of the arm or leg. This usually starts about 48 hours after your treatment. The redness of the skin will gradually fade to brown. This may be quite dark at first, but will become lighter over the next few months.
The skin colour is usually back to normal after about six months. But you may have a permanent change of skin colour in your arm or leg. You will also lose any hair you had on your arm or leg. Some people have some blisters or peeling skin on the sole of the foot or palm of the hand.
Risk of blood clots
While you are recovering in hospital, your nurse will listen to the pulse and blood flow in your arm or leg every day. This is because there is a risk of developing a blood clot in your arm or leg. If you have pain anywhere in your limb, tell your doctor or nurse straight away because this may be a sign of a blood clot. If you do get a blood clot, you will have anti clotting drugs. You will have to stay in bed a little longer.
Rare side effects
On rare occasions, small amounts of the chemotherapy may get into the rest of the body. Depending on the drug, this can cause mild kidney or liver problems. But a reaction like this is usually temporary. And your doctors and nurses will be checking for it. So it should be picked up quickly if it happens to you.
Possible long term effects
There can be long term side effects, such as:
- swelling in the treated arm or leg (lymphoedema)
- muscle wasting
New combinations of chemotherapy and biological therapy drugs are tried in regional chemotherapy from time to time. So your doctors may not know exactly what the long term side effects of your treatment will be. If you have the treatment as part of a clinical trial, the staff will tell you as much as they can before you start the treatment.