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Isolated limb infusion with hyperthermia and chemotherapy for advanced limb malignancy: factors influencing toxicity
Author(s) -
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.
Publication year - 2014
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2012.06249.x
Subject(s) - medicine , melphalan , toxicity , chemotherapy , melanoma , creatine kinase , surgery , gastroenterology , urology , cancer research
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 W ieberdink 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.