Systemic toxicity after isolated limb perfusion with melphalan for melanoma

Area of Science:

• Oncology
• Pharmacology
• Clinical Medicine

Background:

• Isolated limb perfusion (ILP) with melphalan aims to minimize systemic exposure.
• Systemic toxicity following ILP has not been extensively studied.
• Understanding toxicity is crucial for patient safety and treatment protocols.

Purpose of the Study:

• To retrospectively investigate the incidence, nature, and risk factors of systemic toxicity after melphalan ILP.
• To identify patient characteristics and procedural factors associated with systemic side effects.

Main Methods:

• Retrospective analysis of 368 patients undergoing single melphalan ILP (1978-1990).
• Assessment of systemic toxicity, including nausea, vomiting, bone marrow depression, and miscellaneous effects.
• Measurement of systemic leakage using radioactive tracers and correlation with toxicity.
• Statistical analysis to identify risk factors (age, sex, regional toxicity, leakage).

Main Results:

• 27% of patients experienced some systemic toxicity.
• Nausea and vomiting occurred in 20% (requiring treatment in 2%).
• Bone marrow depression (WHO grade II/III) occurred in 2%.
• Miscellaneous side effects (fever, hair loss) occurred in 5%.
• Systemic leakage averaged 0.9% and did not correlate with increased toxicity.
• Female sex, age >60, and severe regional toxicity were associated with increased systemic side effects.

Conclusions:

• Systemic toxicity from melphalan ILP is generally mild and infrequent.
• Nausea and vomiting are the most common side effects.
• Patient factors like age and sex, along with regional toxicity severity, are key risk factors.
• Low systemic leakage during ILP does not appear to increase toxicity risk.