Objective Regression of Unexcised Melanoma in-Transit Metastases After Hyperthermic Isolation Perfusion of the Limbs with Melphalan

Lejeune, Ferdy J.; Deloof, Thierry; Ewalenko, Patricia; Fruhling, Janos; Jabri, Mouna; Maisonneuve, Mathieu; Nogaret, Jean Marie; Verhest, Alain

doi:10.1007/978-3-642-82025-0_45

Cited by 64 publications

(24 citation statements)

References 9 publications

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“…For malignant melanoma of the extremities, normothermic perfusion with melphalan induced 47% CR among 203 patients, while hyperthermic perfusion with the same drug yielded 82% CR in 22 patients (92), and 65% CR and 26% PR in a study including 24 tumours in 23 patients (93). The combination of mild hyperthermia (40-40, 5°C for 90 min) with high-dose TNFh, interferon and melphalan have further increased the response rate to 90% CR and 10% PR in 29 patients (94).…”

Section: Malignant Melanomamentioning

confidence: 99%

Status of Clinical Hyperthermia

Dahl

Dalene²,

Bc³

et al. 1999

Acta Oncologica

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Section: Malignant Melanomamentioning

confidence: 99%

Status of Clinical Hyperthermia

Dahl

Dalene²,

Bc³

et al. 1999

Acta Oncologica

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“…Aun así, la detección de fugas hacia la circulación sisté-mica es primordial, y para ello se utiliza albúmina marcada con iodo 131 o eritrocitos marcados con tecnecio 99 y una gamma sonda o gamma cámara en la región precordial. Con este método se pueden detectar pérdidas inferiores al 1% 34,35 ; en el caso de fugas > 5%, se recomienda suspender el procedimiento debido al riesgo de toxicidad sistémica 17 . Una vez administrados los fármacos, la perfusión se concluye realizando un lavado con solución salina y dextrán (Haemacel ® ) o solución salina y concentrado eritrocitario; se interrumpe el circuito, se desconecta la bomba de perfusión, se desinfla el torniquete y se remueven las cánulas.…”

Section: Procedimientounclassified

“…En la actualidad, no sólo se perfunden agentes quimioterápicos (v. gr., melfalán 17 ), sino también inmunoterápicos (v. gr., factor de necrosis tumoral α [TNF-α] 18,19 ).…”

Section: Introductionunclassified

Consideraciones perioperatorias en el paciente oncológico sometido a perfusión aislada de la extremidad

Cuéllar-Guzmán¹,

Ferretiz-López²,

Cárdenas-Herrera³

2022

GAMO

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Gaceta Mexicana de Oncologia. 2017;16(5):289-294 Resumen La perfusión aislada de la extremidad (PAE) y la perfusión hipertérmica aislada de la extremidad (PHAE) son procedimientos utilizados para el tratamiento de diversos tumores localizados en las extremidades (primordialmente melanoma y tumores de tejidos blandos), inducen una elevada tasa de respuesta tumoral y se asocian a una elevada tasa de salvamento de la extremidad, representando una alternativa a la amputación. Se trata de procedimientos complejos y con una elevada dificultad técnica que requieren del esfuerzo de todo un equipo multidisciplinario (cirujano, anestesiólogo, enfermera, perfusionista e intensivista). Los cambios hemodinámicos, la fuga de los fármacos a través de vasos colaterales, su toxicidad local y sistémica, así como las potenciales complicaciones, requieren de la monitorización continua e invasiva durante el procedimiento y de una estrecha vigilancia posquirúrgica. El propósito de este artículo de revisión fue analizar las pautas para el abordaje perioperatorio del paciente oncológico que se somete a este procedimiento. (creativecommons.org/licenses/by-nc-nd/4.0/). abstract Isolated limb perfusion (ILP) and hyperthermic ILP (HILP) are therapeutic options for patients with unresectable malignancies in the extremities (e.g. primarily melanoma and soft tissue tumors), they induce a high rate of tumor response; associates with high limb salvage rates and represents an effective alternative to amputation. These are challenging procedures with a high technical difficulty that require the efforts of a multidisciplinary team (surgeon, anesthesiologist, nurse, perfusionist and intensivist). Hemodynamic changes, drug leakage through collateral vessels, local and systemic toxicity, and potential complications require continuous and invasive monitoring during the procedure and rigorous post-surgical monitoring. The purpose of this review article was to update the strategies for the perioperative care of cancer patients undergoing this procedure.

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“…As most have recurrent diseases, and a few neglected primaries, the poor prognosis means that perfu sion for these patients must be considered as palliative. This palliation, however, is effective and in most cases long-lasting [16,18,20]. In the past these patients had to undergo amputa- Ref.…”

Section: Indications For Perfusionmentioning

confidence: 99%

Regional Isolated Limb Perfusion in Patients with Malignant Melanoma

et al. 1993

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In this overview the Amsterdam/Rotterdam ‘controlled’ normothermic (tissue temperatures 37-38 °C) perfusion technique is described. The benefit of the widely used so-called ‘mild’ hyperthermia (39-40°C) is queried. A plea is made to report acute regional toxicity after perfusion according to Wieberdink’s grading system for uniformity. Perfusion has a well-established role in the treatment of locally inoperable melanoma. As an adjunct to surgery, benefit has also been shown in resectable stage II–III recurrent melanoma. For stage I primary melanoma the results of the ongoing EORTC/WHO adjuvant trials are eagerly awaited. In measurable disease an overall response rate of about 80% (with equal proportions of complete and partial remissions) can be obtained by single normothermic or ‘mild’ hyperthermic perfusion. Perfusion strategies that have been investigated to improve the complete response rate are discussed: the application of other cytostatics than melphalan, the role of repeat perfusions, perfusion with melphalan at borderline ‘true’ hyperthermic temperatures (40.5-42°C), sequential perfusion applying ‘true’ hyperthermia (42-43°C) and melphalan separately, and perfusion with the combination of rTNF-alpha, Inter-feron-gamma and melphalan. The ideal of a 100% complete remission rate has been approached in several perfusion strategies but the duration of remission is still rather short. The main issue for the immediate future will therefore be prolongation of the limb recurrence-free interval.

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Objective Regression of Unexcised Melanoma in-Transit Metastases After Hyperthermic Isolation Perfusion of the Limbs with Melphalan

Cited by 64 publications

References 9 publications

Status of Clinical Hyperthermia

Status of Clinical Hyperthermia

Consideraciones perioperatorias en el paciente oncológico sometido a perfusión aislada de la extremidad

Regional Isolated Limb Perfusion in Patients with Malignant Melanoma

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