New procedure saving lives and limbs for melanoma patients

May is Melanoma Awareness Month and as summer creeps closer it's important to protect your skin. People diagnosed with meta-static melanoma in their arms or legs can't always protect their limbs from the cancer and can lose them.

Now there's a way to help save lives and limbs from the disease.

Eileen Zbignewich has tender memories of her late husband Ziggy. Together 62 years, the couple met when Ziggy returned home from World War II. Eileen was his nurse.

Ellen Zbignewich was diagnosed with melanoma says, "I was working on the amputee ward and so I took care of him at that time when he lost his leg."

Ten years after her husband died, Eileen was in jeopardy of losing her leg, because of melanoma.

Eileen said, "It's just unbelievable."

The condition often leads to amputation but a new minimally invasive procedure known as isolated limb infusion or ILI is changing that.

Director of Gastrointestinal Oncology Mercy Medical Center Baltimore, MD, Dr. Vadim Gushchin explains how the new treatment is different. "The new idea is to put small catheters into the vessel instead of making incisions."

First doctors isolate the affected limb with a tourniquet. Then a catheter delivers high doses of chemotherapy directly to the limb, targeting the cancer, by isolating the limb.

Dr. Gushchin says, "The drug does not enter the systemic circulation. It does not kill the patient."

The survival rate for metastic melanoma in the limbs used to be one in ten. ILI has tripled that, and another third of patients experience a slowdown of the disease.

Eileen is one of them. She had ILI two years ago. Now the cancer has come back. "Fortunately my melanoma has been isolated to just this leg."

She's a candidate for another ILI procedure and is focusing on keeping her leg.

The outpatient procedure takes about two hours to complete. At the end of the procedure the chemo drugs are flushed out of the limbs and circulation is returned to normal.

Just like in Eileen's case, it can be repeated if necessary.


REPORT: MB # 3458

BACKGROUND: Isolated limb infusion (ILI) is a procedure used to deliver anticancer drugs directly to an arm or leg but not to the rest of the body. The flow of blood to and from the limb is temporarily stopped with a tourniquet (a tight band around the limb). This allows for large doses of chemotherapy medications to be administered without poisoning the rest of the body.

Catheters (small, flexible tubes) attached to a pump are put into an artery and a vein in the limb so that blood can be circulated through the pump into the limb. High doses of anticancer drugs are then injected into the catheters.

The procedure is used to control advanced melanoma or soft tissue sarcoma of the extremity. (Source: The Institute for Cancer Care at Mercy Hospital)

TREATMENT OPTIONS: ILI is preferred to other methods of treatment because it helps avoid amputation of the cancerous arm or leg. There is no other effective chemotherapy that can prevent this tumor from growing. Without treatment it will eventually become large, non-healing wounds with bleeding craters and repeated infections.

In the past, one of the most effective strategies for treatment involved surgically inserting large catheters in the main vessel of the leg and perfusing high dose chemotherapy using a heart-lung machine. Today, Isolated Limb Infusion, a minimally invasive technique that uses the same principle of regional high dose chemotherapy but through smaller catheters (cardiologists use similar catheters to study vessels of the heart) is the state of the art treatment for patients with locally recurrent melanoma and some other malignances.

A majority of patients have a durable response. ILI requires cooperation between multiple services: surgical oncology, interventional radiology, operating room, anesthesia, pharmacy and others to administer this treatment safely and effectively.

The Institute for Cancer Care at Mercy is one of the few oncology centers in the country to offer this sophisticated treatment for patients with advanced melanoma, sarcoma and some other tumors of the extremities.

Tumor shrinkage can be seen in as little as 90-120 days and can be repeated if necessary.


Vadim Gushchin, MD
Mercy Medical Center
(410) 332-0212

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