Chemotherapy into the arm or leg

Chemotherapy into the arm or leg is also called regional chemotherapy. It’s a way of having chemotherapy into one arm or leg, without the drugs circulating through the rest of your body.

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. A surgeon usually gives you regional chemotherapy. You have it under general anaesthetic, which means you’re asleep for this treatment.

When you have it

Doctors only use regional chemotherapy if your melanoma skin cancer has come back in an arm or leg very near to where it started. This is called a locoregional or regional recurrence.

Types of regional chemotherapy

There are 2 types of regional chemotherapy for melanoma. They are:

• isolated limb infusion
• isolated limb perfusion

Your doctor or specialist nurse (key worker) will tell you what treatment you’ll be having.

Isolated limb infusion (ILI)

Before the operation

Your doctor will check how well your blood vessels work in the affected limb. Your nurse also measures your arm or leg (your limb) so they can work out how much chemotherapy you can have. They use a special machine called a perometer, which uses infrared light to measure your limb.

You go to a pre assessment clinic to check you're well enough to have a general anaesthetic. This usually includes:

• taking measurements, such as your heart and breathing rate, blood pressure, temperature and weight
• blood tests (if you need them)
• a heart trace to check the rhythm and electrical activity of your heart (an electrocardiogram or ECG)

Having a general anaesthetic means that you need to stop eating and drinking before your operation. This usually means no food for 6 hours before your operation. But you can usually drink water up to 2 hours beforehand.

Tell your team if this will be a problem for you, for instance if you have diabetes.  

On the day

Your surgical team talk to you again about your operation. They ask you to sign a consent form to agree to the operation if you haven't signed one already. This is a good time to ask any questions you may have.

Before the operation, a specialist doctor puts tubes (catheters) into the blood vessels that carry blood in and out of your arm or leg. You have this in the x-ray department with medicine to numb the area (local anaesthetic).

You then go to the operating theatre. You have a general anaesthetic. This sends you into a deep sleep. When you wake up, the operation will be over.

Your surgeon puts a type of bandage (tourniquet) around the limb. This stops the blood supply circulating to the limb from the rest of your body.  And it stops the chemotherapy travelling to the rest of your body. They also use a medicine to prevent your blood from clotting. 

Your surgeon then connects the catheters to a pump and a machine that puts chemotherapy into the blood. 

The chemotherapy circulates around your limb for about 25 minutes. A heater might warm up the blood. This helps the chemotherapy to work better. Your surgeon keeps a close eye on the temperature to make sure it’s at a safe level.

At the end of treatment, they flush your limb with salty water (saline) to get rid of the drug. They remove the tourniquet so the circulation to your limb returns to normal. They also take out the catheters.

After the operation

After the operation, you go to the recovery area. When you’re more awake you will return to the ward.

You need to stay in hospital after this treatment. Your doctor will tell you how long you might need to stay in. You usually stay in hospital for between 3 to 7 days. 

You have to stay in bed for several days while you recover. It’s a good idea to take in reading material and things to keep you occupied whilst you rest.

Your nurses will keep a close eye on your affected limb. They will measure and feel it regularly. It’s important you let them know if you are in any pain.

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.

Side effects

You don't have the usual side effects of chemotherapy with this type of treatment. This is because the drugs don't circulate through the rest of your body in high enough amounts. 

Soreness

Your shoulder or groin will be sore where the catheters 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. 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.  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. 

Rarely, you may need another operation to remove a clot if it occurs in the limb you had the chemotherapy. 

Change in sensation

You might have some changes to sensation to the limb that’s had treatment. This may feel like pins and needles. Let your doctor or nurse know and if you’re in pain.

Hair loss and nail changes

You might lose hair to the affected limb, and the hair may stop growing for a while. Your nails may also stop growing in that limb.

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

From time to time, new combinations of chemotherapy and targeted cancer drugs or immunotherapy are tried in regional chemotherapy. 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 team will tell you as much as they can before you start the treatment.