Systemic leakage during isolated limb perfusion for melanoma

Area of Science:

• Oncology
• Surgical Oncology
• Pharmacology

Background:

• Regional perfusion is a treatment for melanoma, but incomplete isolation can lead to systemic leakage of cytostatic drugs.
• Melphalan is a commonly used cytostatic drug in this procedure.
• Understanding and minimizing systemic leakage is crucial for patient safety and treatment efficacy.

Purpose of the Study:

• To retrospectively analyze systemic leakage of melphalan during regional perfusion for melanoma.
• To identify factors influencing systemic leakage and patient side-effects.
• To evaluate the effectiveness of specific perfusion techniques in minimizing drug extravasation.

Main Methods:

• Retrospective analysis of 438 melphalan perfusions for extremity melanoma (1978-1990).
• Continuous isotopic measurement of systemic leakage during perfusion.
• Multivariate analysis of six perfusion technique variables to assess their impact on systemic leakage.

Main Results:

• Cumulative systemic leakage after 60 minutes was 0.9% (95% CI 0.7-1.1%).
• Significant systemic leakage (≥1%) occurred in 12.6% of perfusions.
• Mild transient bone marrow depression was observed in 2.3% of patients; isolation level and venous cannula diameter were significant factors influencing leakage. Ligation of the internal iliac vein optimized isolation during iliac perfusion.

Conclusions:

• Optimizing the isolation technique during regional perfusion is critical to minimize systemic melphalan leakage.
• The level of isolation and venous cannula diameter are key factors influencing drug extravasation.
• Ligation of the internal iliac vein is recommended for enhanced isolation in iliac perfusions.