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Tourniquet infusion versus hyperthermic perfusion

C P Karakousis, P M Kanter, H C Park

    Cancer
    |March 1, 1982
    PubMed
    Summary
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    Tourniquet infusion achieved higher drug levels in canine limbs compared to hyperthermic perfusion. This method showed promise for treating extremity tumors, with complete or partial regression observed in multiple cases.

    Area of Science:

    • Oncology
    • Surgical Oncology
    • Pharmacology

    Background:

    • Limb salvage surgery is crucial for extremity tumors.
    • Regional chemotherapy delivery methods aim to maximize drug concentration at the tumor site while minimizing systemic toxicity.
    • Hyperthermic perfusion is an established technique, but alternative methods warrant investigation.

    Purpose of the Study:

    • To compare the efficacy of tourniquet infusion versus hyperthermic perfusion for delivering chemotherapy drugs (Adriamycin, actinomycin-D, melphalan) to canine limbs.
    • To evaluate the resulting tissue drug levels and systemic drug leak.
    • To assess the clinical outcomes of tourniquet infusion in treating extremity tumors.

    Main Methods:

    • Canine limbs were treated with Adriamycin, actinomycin-D, and melphalan using either tourniquet infusion or hyperthermic perfusion.

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  • Tissue drug levels and systemic leak were quantified.
  • Clinical response of extremity tumors to tourniquet infusion was documented, including complete and partial regressions.
  • Preoperative tourniquet infusion was used in five patients with extremity sarcomas.

    • Main Results:

    • Tourniquet infusion yielded comparable Adriamycin tissue levels and significantly higher actinomycin-D and melphalan levels compared to hyperthermic perfusion.
    • Higher systemic drug leak was observed with tourniquet infusion, particularly with melphalan.
    • Tourniquet infusion resulted in complete regression of four extremity tumors and partial regression (>50%) of nine tumors.
    • Five patients with sarcomas received preoperative tourniquet infusion.

    Conclusions:

    • Tourniquet infusion is a viable method for delivering chemotherapy to extremity tumors, achieving high local drug concentrations.
    • While systemic leak is a consideration, the observed tumor regressions suggest therapeutic potential.
    • Further studies with larger patient cohorts and longer follow-up are necessary to definitively compare tourniquet infusion with hyperthermic perfusion.