PS-005 Effectiveness and toxicity of hyperthermic isolated limb perfusion with antitumor drugs in treatment of in-transit metastases of melanoma and sarcoma

Abstract

BackgroundHyperthermic isolated limb perfusion (HILP) is a regional treatment of advanced limb cancers with antitumor drugs (melphalan and tumour necrosis factor (TNF)) under hyperthermic conditions. The use of TNF might be challenging as it can cause cardiogenic shock in pharmacological dosages. The Institute of Oncology Ljubljana (OIL) is one of a few institutions which have special accreditation for using TNF during HILP. HILP is indicated in patients with regionally advanced melanoma or limb sarcomas where amputation would be the only possible treatment.PurposeThe aim of this retrospective study was to assess regional and systemic toxicity and other postoperative complications in 51 cases of HILP. A review of the effectiveness of treatment with overall response rate is also included.Material and methodsFrom 2010 to 2015, 51 patients with in-transit melanoma or sarcoma metastases were treated with HILP at OIL. During the procedure, the vessels in the lower/upper limb are isolated and connected to the heart-lung machine. First, the isolated limb is warmed to about 40°C and leakage measurements are performed. If there is no leakage, antitumour drug is applied at a dosage 10–20 times higher than the maximal doses allowed for systemic application. At the end, the limb is washed out and the vessels are repaired. The Wieberdink grading system was used to evaluate the regional toxic effect. Most systemic side effects are caused by leakage of drugs into the systemic circulation.ResultsRegional toxicity was classified using the 5 grade Wieberdink system. In this study, most of the patients had grade I toxicity (70.58%), however in 1.96%, grade V regional toxicity occurred. In 6 cases systemic toxicity occurred; 3.92% of patents had muscle wasting with elevated myoglobin, 1.96% of patients had thrombosis and 5.88% of patients had systemic inflammatory response syndrome. 10 patients had treatment related complications such as lymphoedema, bleeding, paresis and infection.ConclusionHILP is an effective treatment with complete response rates reaching up to 90% in patients with melanoma and sarcoma. Due to the systemic and local toxicity of antitumour drugs, close collaboration between the clinical pharmacist and surgeon during HILP is highly recommended.No conflict of interest.