Isolated limb infusion with hyperthermia and chemotherapy for advanced limb malignancy: factors influencing toxicity

• Published in: ANZ journal of surgery Vol. 84; no. 9; pp. 677 - 682
• Main Authors: Duprat Neto, João Pedreira, Mauro, Ana Carolina C., Molina, Andre S., Nishinari, Kenji, Zurstrassen, Charles E., Costa, Odon F., Belfort, Francisco A., Facure, Luciana, Fregnani, José H.
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.09.2014
• Subjects: Adult; Aged; Antineoplastic Agents - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy; Chemotherapy, Cancer, Regional Perfusion - adverse effects; Chemotherapy, Cancer, Regional Perfusion - methods; Combined Modality Therapy; Dactinomycin - administration & dosage; Dose-Response Relationship, Drug; Extremities; Female; Humans; Hyperthermia, Induced; hypoxia; isolation limb infusion; Male; Melanoma; Melanoma - therapy; Melphalan - administration & dosage; Middle Aged; regional chemotherapy; Skin Neoplasms - therapy; Toxicity; Treatment Outcome; isolation limb infusion; hypoxia; melanoma; regional chemotherapy
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/j.1445-2197.2012.06249.x

Background The isolated limb infusion (ILI) technique is a simpler and less invasive alternative to isolated limb perfusion, which allows regional administration of high‐dose chemotherapy to patients with advanced melanoma and other malignancies restricted to a limb. Methods Patients from two institutions, treated by ILI between 1998 and 2009 for extensive disease restricted to a limb, were included. The cohort included 31 patients with melanoma who presented with in‐transit metastases or an extensive primary lesion, one patient with squamous cell carcinoma and another with epithelioid sarcoma not suitable for local surgical treatment. Results A complete response was achieved in 26.3% of patients and a partial response in 52.6%. Toxicity was assessed according to the Wieberdink limb toxicity scale. Grade II toxicity was noted in 39.5% of patients, grade III in 50% and grade IV in 10.5%. Toxicity was correlated with the results of a number of clinical and laboratory tests. The toxicity of melphalan and actinomycin D was dose‐dependent. For melphalan, the relationship between toxicity and mean dose was as follows: grade II – 34.7 mg; grades III and IV – 47.5 mg (P = 0.012). The relationship between toxicity and maximum serum creatine phosphokinase (CPK) was as follows: grade II – 431.5 U/L; grades III and IV – 3228 U/L (P = 0.010). Conclusion Toxicity after ILI is dose‐dependent and serum CPK correlates with toxicity.