Isolated limb infusion with hyperthermia and chemotherapy for advanced limb malignancy: factors influencing toxicity
- J. P. Duprat Neto MD, PhD; A. C. C. Mauro MD; A. S. Molina MD; K. Nishinari PhD; C. E. Zurstrassen MD; O. F. Costa MD; F. A. Belfort MD, PhD; L. Facure MD, MSc; J. H. Fregnani MD, PhD.
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.
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.
A complete response was achieved in 26.3% of patients and a partial response in 52.6%. Toxicity was assessed according to the Wieberdink 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).
Toxicity after ILI is dose-dependent and serum CPK correlates with toxicity.