Isolated limb perfusion with hyperthermia and chemotherapy: predictive factors for regional toxicity

• Published in: Clinics (São Paulo, Brazil) Vol. 67; no. 3; pp. 237 - 241
• Main Authors: Neto, João Pedreira Duprat, Oliveira, Fernanda, Bertolli, Eduardo, Molina, Andre Sapata, Nishinari, Kenji, Facure, Luciana, Fregnani, Jose Humberto
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier España, S.L.U 01-01-2012; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; Faculdade de Medicina / USP; Elsevier España
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents, Alkylating - administration & dosage; Antineoplastic Agents, Alkylating - adverse effects; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Body Weight - physiology; Chemotherapy, Cancer, Regional Perfusion - adverse effects; Chemotherapy, Cancer, Regional Perfusion - methods; Clinical Science; Creatine Kinase - blood; Drug Dosage Calculations; Female; Humans; Hypoxia; Isolation Perfusion Cancer Chemotherapy; Leg; Male; MEDICINE, GENERAL & INTERNAL; melanoma; Melanoma - drug therapy; Melanoma - enzymology; Melphalan; Melphalan - administration & dosage; Melphalan - adverse effects; Middle Aged; Regional chemotherapy; Retrospective Studies; Risk Factors; Skin Neoplasms - drug therapy; Skin Neoplasms - enzymology; Statistics, Nonparametric; Young Adult; Hypoxia; melanoma; Isolation Perfusion Cancer Chemotherapy; Regional chemotherapy; Melphalan
• ISSN: 1807-5932; 1980-5322; 1980-5322
• DOI: 10.6061/clinics/2012(03)06

Isolated limb perfusion combined with melphalan is an accepted treatment for obtaining locoregional control in advanced melanoma of the extremities and other malignant neoplasias restricted to the limb. This study aims to examine the factors associated with toxicity caused by the regional method. We considered the technical aspects of severe complications associated with the procedure in an attempt to diminish the patient morbidity that occurs during the learning curve.
We conducted a retrospective analysis of the records of patients who underwent perfusion at the AC Camargo Hospital in São Paulo, Brazil between January 2000 and January 2009. The Wieberdink scale was applied to classify local toxicity and its relation to clinical and laboratory variables.
Fifty-eight perfusions were performed in 55 patients. Most patients (86.2%) presented a toxicity level between I and III. Grade V toxicity was seen in five cases (8.6%), four of which occurred in the first 2 years. Creatine phosphokinase, an important predictive factor for toxicity, had an average value of 231.8 for toxicity grades I-III and 1286.2 for toxicity grades IV-V (p = 0.001). There was a relationship between the melphalan dose and toxicity, which was 77 mg (25 to 130 mg) for toxicity grades I-II and 93.5 mg (45 to 120 mg) for toxicity grades IV-V (p = 0.0204).
It is possible to prevent the toxicity associated with melphalan by adjusting the dose according to the patient's body weight (especially for women and obese patients) and the creatine phosphokinase values in the postoperative period.