Patient with metastatic melanoma receives minimally invasive high-dose regional chemotherapy
Surgeons at the McGill University Health Centre have successfully carried out the first Isolated Limb Infusion (ILI) procedure ever performed in Quebec. Performed by Dr. Ari Meguerditchian, MUHC surgical oncologist, on a patient with recurrent metastatic melanoma confined to his right leg, the ground-breaking procedure was a total success. Today, the patient is completely cancer free.
ILI is suited to patients with recurrent melanoma confined to a limb that cannot be treated by traditional surgery. It avoids the need for amputation or lengthy surgical procedures and allows large doses of anti-cancer drugs to be delivered to the limb without affecting the rest of the body. The ILI procedure offers a reasonable chance of long-term tumour control and even cure, and complications are rare.
“When you have a cancer that spreads regionally instead of going systemically, this gives you a chance to intervene before it travels to other parts of the body,” says Dr. Meguerditchian. “The isolated limb infusion is a minimally invasive technique that allows you to deliver high-dose chemotherapy in patients that have regional occurrence of disease. It is repeatable, there are less side effects, less risks and equal benefits to the patient. Additionally, it is less resource intensive for the institution than the traditional alternatives.”
Declared cancer free just days ago, the patient considers how lucky he is to have been offered this innovative procedure. “Although I have experienced some side-effects, I would happily take them over the alternative! The whole procedure happened in one half hour. That is pretty amazing when you think of the number of sessions of chemotherapy many other patients have to go through.”
A highly-targeted procedure
ILI involves “isolation” of the affected arm or leg from the rest of the body using a tourniquet, which blocks off the normal blood supply to the limb and keeps the anti-cancer drugs confined to that area. Next, small calibre arterial and venous catheters (tubes) are inserted through the skin from the opposite groin and positioned right at the level of the tumor. Later that day, in the operating theatre, the actual infusion of anti-cancer drugs is performed (normally after a full general anaesthetic has been given).
Before the anti-cancer drugs are injected into the limb, a tourniquet is placed around the upper part of the limb to prevent leakage into the general circulation of the body. During the ILI procedure, the blood circulating through the limb is warmed by passing it through a heating coil, because the effectiveness of the anti-cancer drugs is increased at raised temperatures. The period during which the limb is exposed to the anti-cancer drugs is normally 30 minutes. The total procedure in the operating theatre usually takes less than an hour.
Continuing to improve cancer treatment
According to Dr. Meguerditchian, ILI is only one of the varieties of regional therapeutic tools that can be applied to cancer. “At the MUHC we are interested in developing and improving these new treatment modalities and further contributing to scientific knowledge,” he says.
Dr. Meguerditchian is also quick to mention that this first success was made possible by the high degree of coordination achieved between a number of hospital services, including: pharmacy, radiology, perfusionists, nursing and surgery. “This was a team effort and it is only thanks to everyone’s dedication and professionalism that we made it work. This collaborative spirit will be the key as we venture to explore new treatment modalities.”
The McGill University Health Centre (MUHC) is a comprehensive academic health institution with an international reputation for excellence in clinical programs, research and teaching. Its partner hospitals are the Montreal Children's Hospital, the Montreal General Hospital, the Royal Victoria Hospital, the Montreal Neurological Hospital, the Montreal Chest Institute and the Lachine Hospital. The goal of the MUHC is to provide patient care based on the most advanced knowledge in the health care field and to contribute to the development of new knowledge.www.muhc.ca