Isolated limb perfusion with hyperthermia and chemotherapy: predictive factors for regional toxicity

Abstract

OBJECTIVE:Isolated limb perfusion combined with melphalan is an accepted treatment for obtaining locoregional control in advanced melanoma of the extremities and other malignant neoplasias restricted to the limb. This study aims to examine the factors associated with toxicity caused by the regional method. We considered the technical aspects of severe complications associated with the procedure in an attempt to diminish the patient morbidity that occurs during the learning curve.METHODS:We conducted a retrospective analysis of the records of patients who underwent perfusion at the AC Camargo Hospital in São Paulo, Brazil between January 2000 and January 2009. The Wieberdink scale was applied to classify local toxicity and its relation to clinical and laboratory variables.RESULTS:Fifty-eight perfusions were performed in 55 patients. Most patients (86.2%) presented a toxicity level between I and III. Grade V toxicity was seen in five cases (8.6%), four of which occurred in the first 2 years. Creatine phosphokinase, an important predictive factor for toxicity, had an average value of 231.8 for toxicity grades I-III and 1286.2 for toxicity grades IV-V (p = 0.001). There was a relationship between the melphalan dose and toxicity, which was 77 mg (25 to 130 mg) for toxicity grades I-II and 93.5 mg (45 to 120 mg) for toxicity grades IV-V (p = 0.0204).CONCLUSION:It is possible to prevent the toxicity associated with melphalan by adjusting the dose according to the patient's body weight (especially for women and obese patients) and the creatine phosphokinase values in the postoperative period.

Radionuclide leakage monitoring during hyperthermic isolated limb perfusion for treatment of local melanoma metastasis in an extremity

“…Systemic toxicity in ILP is closely related to the amount of leakage of cytotoxic drug to the systemic circulation (Duprat Neto et al ., ). As mentioned above, it is generally recommended to interrupt the procedure at ≥10% leakage.…”

Drug dosage in isolated limb perfusion: evaluation of a limb volume model for extremity volume calculation

“…The safety of isolated limb perfusion and isolated limb infusion depends on a variety of parameters. One of these parameters is the correct dosage of the drugs administered during the procedure [ 13 , 30 ]. This is very much dependent on the volume of the extremity [ 16 , 17 ].…”

Indocyanine Green for Leakage Control in Isolated Limb Perfusion

“…In the past few years, there has been a great effort within oncologic research to develop improved drug delivery systems and application modes that enable a high local efficacy while keeping systemic toxic effects at the lowest level possible. In this regard, isolated limb perfusion (ILP) has been described as a technique that permits the local application of high-dose cytostatic drugs into tumors or metastases located within extremities [9][10][11]. The technique is mostly used for the treatment of locally advanced melanoma and unresectable primary or recurrent sarcomas of the limb [12][13][14].…”