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Physiological implications of hyperbaric oxygen tensions in isolated limb perfusion using melphalan: a pilot study
B C Vrouenraets1, B B Kroon, S A van de Merwe
1Department of Surgery, Netherlands Cancer Institute (Antoni van Leeuwenhoek ziekenhuis), Amsterdam, The Netherlands.
Summary
Increasing oxygen levels during isolated limb perfusion (ILP) with melphalan improves muscle pH but may reduce melphalan
Area of Science:
- Oncology
- Surgical Oncology
- Pharmacology
Background:
- Optimal perfusate oxygen levels during isolated limb perfusion (ILP) with melphalan are debated.
- Hyperbaric oxygen tensions may impact ILP efficacy and patient outcomes.
Purpose of the Study:
- To investigate the effects of increased perfusate oxygen tension on tissue pH and blood gases during ILP with melphalan.
- To assess the implications of hyperbaric oxygen on melphalan's therapeutic effect.
Main Methods:
- 12 patients undergoing ILP for melphalan treatment were monitored.
- Subcutaneous pO2, tissue/tumor pH, and blood gases were measured throughout the procedure.
- Oxygen supply was increased 30 minutes prior to ILP completion.
Main Results:
- Increased perfusate oxygen significantly improved muscle tissue pH.
- Subcutaneous pO2 levels rose substantially with higher oxygen supply.
- Tumor pH showed a trend towards increase, potentially impacting melphalan cytotoxicity.
Conclusions:
- Elevated perfusate pO2 during ILP enhances muscle tissue oxygenation and pH.
- The rise in tumor pH with increased oxygen may diminish melphalan's therapeutic effectiveness due to reduced cytotoxicity at higher pH.
- Further research is needed to optimize oxygen levels for ILP with melphalan.