Dosimetry in isolation perfusion of the limbs by assessment of perfused tissue volume and grading of toxic tissue reactions

Wieberdink, J; Benckhuysen, C.; Braat, R. P.; Slooten, E. A. van; Olthuis, G

doi:10.1016/0277-5379(82)90235-8

Cited by 431 publications

(178 citation statements)

References 5 publications

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“…Postoperatively limb toxicity (recorded using the scale proposed by Wieberdink et al [ Table 1]) 14 and systemic toxicity were assessed daily along with measurements of the serum creatine phosphokinase (CK) level. CK levels exceeding 1000 IU/L can be associated with serious toxicity.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of repeat isolated limb infusion with melphalan and actinomycin D for recurrent melanoma

Kroon

Lin

Kam

et al. 2009

Cancer

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BACKGROUND:Isolated limb infusion (ILI) is an effective and minimally invasive treatment option for delivering regional chemotherapy in patients with metastatic melanoma confined to a limb. Recurrent or progressive disease after an ILI, however, presents a challenge for further treatment. The value of repeat ILI in this situation has not been well documented.METHODS:Forty‐eight patients were identified who had been treated with a repeat ILI. In all patients, a cytotoxic combination of melphalan and actinomycin D was used.RESULTS:The median time between the 2 procedures was 11 months. The complete response (CR) rate after repeat ILI was 23%, compared with 31% after the initial ILI (P = .36). The overall response was 83%, compared with 75% after the first procedure (P = .32). The median duration of response was 11 months (10 months for patients with CR; P = .80), and median survival was 38 months. In those patients achieving a CR, the median survival was 68 months (P = .003). Toxicity after repeat ILI was increased, with 20 patients experiencing Wieberdink grade III limb toxicity (considerable erythema and edema with blistering) and 5 patients experiencing grade IV toxicity (threatened or actual compartment syndrome), whereas after the initial ILI these toxicity grades occurred in 14 patients and 1 patient, respectively (P = .03). No patient experienced grade V toxicity (requiring amputation).CONCLUSIONS:Repeat ILI is an attractive treatment option to achieve limb salvage in patients with inoperable recurrent or progressive melanoma after a previous ILI. It can be associated with significant short‐term regional toxicity, but is well tolerated by most patients, with satisfactory response rates. Cancer 2009. © 2009 American Cancer Society.

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Section: Methodsmentioning

confidence: 99%

Efficacy of repeat isolated limb infusion with melphalan and actinomycin D for recurrent melanoma

Kroon

Lin

Kam

et al. 2009

Cancer

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“…Acute regional toxicity was graded from 1 to 5 according to Wieberdink et al 16 Systemic toxicity was measured according to Common Toxicity Criteria. 17 Signs that were evaluated were nausea/emesis, fever, hypotension, rhythm disturbances, serum bilirubin, alanine aminotransferase, aspartate aminotransferase, white blood cell count, and platelet count.…”

Section: Complications and Toxicitymentioning

confidence: 99%

Isolated limb perfusion with tumor necrosis factor‐α and melphalan for patients with unresectable soft tissue sarcoma of the extremities

Noorda

Vrouenraets

Nieweg

et al. 2003

Cancer

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BACKGROUNDSince 1992, isolated limb perfusion (ILP) with tumor necrosis factor‐α (TNFα) and melphalan has been used for the treatment of patients with unresectable soft tissue sarcomas of the extremities. The authors retrospectively studied the results of limb salvage surgery using TNFα‐ILP at their institution.METHODSFrom 1992 to 2001, 49 patients (mean age, 51 years; range, 14–85 years) underwent ILP for unresectable soft tissue sarcomas of the extremities. All patients received melphalan and TNFα (four patients also received interferon‐γ). The median follow‐up was 26 months (range, from 2 days to 103 months).RESULTSIn 1 patient (2%) who died 2 days after undergoing ILP, response and acute limb toxicity could not be assessed. One patient (2%) attained a clinical complete response (2%), 23 patients (47%) attained a clinical partial response, 17 patients (35%) demonstrated no change, and 7 patients (14%) had tumor progression. Thirty‐one patients (63%) underwent tumor resection. Histologic material also was available from eight amputations and three punctures/biopsies. Pathologic response was complete in 4 patients (8%), partial in 14 patients (29%), and no change was observed in 24 patients (49%). Final response, based on both clinical and pathologic assessment in which pathology was decisive, was complete in 4 patients (8%) and partial in 27 patients (55%), resulting in a final overall response rate of 63%. Local control with preservation of the limb was attained in 28 patients (57%). Four of 32 patients (13%) who had been rendered tumor free by ILP with or without undergoing resection and radiation therapy, developed a local recurrence. The 5‐year disease specific survival rate was 48% for the 49 patients. Acute limb toxicity after ILP was a mild Grade 1–2 reaction in 35 patients (71%) patients, a Grade 3 reaction in 12 patients (25%), and a Grade 4 reaction in 1 patient (2%). Three major ILP‐related complications were encountered, including arterial thrombosis in two patients and a fulminant Clostridial infection leading to death in one patient. There were no severe cardiovascular reactions after ILP.CONCLUSIONSIn patients with unresectable soft tissue sarcomas of the limbs who underwent ILP with TNFα and melphalan followed by resection of the tumor remnant when possible, a 63% overall tumor response rate and a 57% local control rate with limb preservation was achieved. Cancer 2003;98:1483–90. © 2003 American Cancer Society.DOI 10.1002/cncr.11648

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“…After 1.5 hours of perfusion, the limb is rinsed with an electrolyte solution, cannulas are removed, and the vessels are repaired. Classification of postoperative limb toxicity was performed according to Wieberdink et al 16 : grade I, no reaction; grade II, slight erythema, edema, or both; grade III, considerable erythema and/or edema with some blistering, slightly disturbed motility permissible; grade IV, extensive epidermolysis and/or obvious damage to the deep tissues, causing definite functional disturbances; threatening or manifest compartmental syndrome; and grade V, reaction that may necessitate amputation.…”

Section: Drugsmentioning

confidence: 99%

Fifty Tumor Necrosis Factor?Based Isolated Limb Perfusions for Limb Salvage in Patients Older Than 75 Years With Limb-Threatening Soft Tissue Sarcomas and Other Extremity Tumors

et al. 2003

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Background: Isolated limb perfusion (ILP) with tumor necrosis factor (TNF) and melphalan is highly effective in treating limb-threatening soft tissue sarcoma (STS) and other bulky tumors. Because of fear of TNF-associated toxicity, ILP with TNF is not offered to older patients in some cancer centers, although especially in older patients, every attempt to avoid an amputation that may end their independence must be considered.Methods: Out of 306 TNF-based ILPs, 50 ILPs were performed for limb salvage in 43 patients Ͼ75 years old (range, 75-91 years): 29 STS and 14 melanoma patients.Results: In the STS patients, a response rate of 76% and a limb-salvage rate of 76% were achieved; in the melanoma patients, a 100% response rate and a 93% limb-salvage rate were achieved. Local toxicity was mild. The three postoperative deaths that occurred in the total series of 306 TNF-based ILPs in Rotterdam (Ͻ1%) occurred in patients Ͼ75 years old after leakage-free perfusions and were not related to TNF but to extremely high-risk profiles in these three patients.Conclusions: Older patients should not be withheld a TNF-based ILP for limb salvage, because the procedure is safe and highly effective in these patients.

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Dosimetry in isolation perfusion of the limbs by assessment of perfused tissue volume and grading of toxic tissue reactions

Cited by 431 publications

References 5 publications

Efficacy of repeat isolated limb infusion with melphalan and actinomycin D for recurrent melanoma

Efficacy of repeat isolated limb infusion with melphalan and actinomycin D for recurrent melanoma

Isolated limb perfusion with tumor necrosis factor‐α and melphalan for patients with unresectable soft tissue sarcoma of the extremities

Fifty Tumor Necrosis Factor?Based Isolated Limb Perfusions for Limb Salvage in Patients Older Than 75 Years With Limb-Threatening Soft Tissue Sarcomas and Other Extremity Tumors

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