Variation in response rates to isolated limb perfusion in different soft-tissue tumour subtypes: an international multi-centre study

Reijers, Sophie; Davies, Emma; Grünhagen, Dirk J.; Fiore, Marco; Honoré, Charles; Rastrelli, Marco; Vassos, Nikolaos; Podleska, Lars Erik; Niethard, Maya; Jakob, Jens; Perhavec, Andraž; Duarte, Carlos; González, Félipe; Deroose, Jan P.; Stas, Marguerite; Boecxstaens, Veerle; Schrage, Yvonne; Snow, Hayden; Martín‐Algarra, Salvador; Saíd, Héctor Martínez; García-Ortega, Dorian Yarih; Martin, Karla; Mattsson, Jan; Djafarrian, Reza; Lorenzo, Giorgia Di; Colombo, Chiara; Gronchi, Alessandro; Matter, Maurice; Verhoef, Cornelis; Bagge, Roger Olofsson; Hohenberger, Peter; Hayes, Andrew; Houdt, Winan J. van

doi:10.1016/j.ejca.2023.112949

Cited by 1 publication

(2 citation statements)

References 30 publications

(33 reference statements)

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“…It is used as a local high-dose chemotherapy combined with hyperthermia to improve the resectability of the tumor and prevent imminent limb amputation in patients with locally advanced tumors. Overall response rates of 68% and overall limb salvage rates between 73.8% and 88% can thus be achieved [3][4][5].…”

Section: Introductionmentioning

confidence: 97%

“…Due to the complexity of the isolated hyperthermic extremity perfusion with high logistical effort, the intervention is only performed in a few sarcoma centers. Statistically relevant case numbers can only be achieved in an international multicentric setting [3], which, however, entails different procedures in the perioperative implementation regarding anesthetic management and surgical technique. For the evaluation of an add-on to the surgical procedure, only an in-house comparison seems reliable where the performing team for the procedure (surgeons/anesthesia/nuclear medicine/medical physics) can be assumed to be a constant parameter.…”

Section: Introductionmentioning

confidence: 99%

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The Use of Regional Anesthesia to Reduce Blood Loss in Isolated Limb Perfusion (ILP)—A Novel Approach

Niethard,

Fischer,

Gaßmann

et al. 2023

JCM

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Background: Isolated limb perfusion (ILP) for soft tissue sarcomas (STS) is usually performed with tumor necrosis factor alpha (TNF-α) and melphalan. ILP regularly leads to a total blood loss (BLt) of 1.5–2 L/patient. Blood inflow from the central blood circulation to the limb is influenced by unstable pressure gradients and pain reactions after the administration of melphalan. With perioperative regional anesthesia (RA), pain levels can be reduced, and the pressure gradient stabilized resulting in a reduced BLt. The aim of this study was to compare the BLt with and without RA in patients with ILP during circulation of drugs. Methods: Patients were treated according to the following protocol: After the establishment of limb circulation, ILP was started with the administration of TNF-α. Half the dose of melphalan was given as a bolus after 30 min, and the remaining dose was continuously administered in the following 30 min. The extremity was washed out after 90 min. ILP with perioperative RA (supraclavicular plexus block/peridural catheter) was performed prospectively in 17 patients and compared to a matched retrospective control group of 17 patients without RA. BLt was documented and perioperative anesthesiological data were analyzed for response rates after the application of melphalan (RaM). Results: BLt and RaM tended to be lower for the intervention group with RA if compared to the control group without RA in all analyses. The trend of lower BLt and RaM in ILP with RA was more pronounced for the upper extremity compared to the lower extremity. Results were not statistically significant. Conclusion: These findings indicate that the use of RA can help to stabilize hemodynamic anesthetic management and reduce the BLt in ILP, especially during perfusion of the upper extremities.

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%