[Relations of chemotherapy-induced tumor necrosis to plasma platin concentration and primary tumor temperature in patients with osteosarcoma in the lower extremities treated by hyperthermic isolation limb perfusion with cisplatin].
OBJECTIVE
To study the relations of chemotherapy-induced tumor necrosis to plasma concentration of platin and primary tumor temperature in hyperthermic isolation limb perfusion (HILP) with cisplatin, and to investigate the correlation between the tumor necrosis rate and the relapse-free survival (RFS).


METHODS
Fifteen patients with II B osteosarcoma in the lower extremities were treated with neoadjuvant chemotherapy. Among them, 10 were male and 5 female. The average age was 18 years (ranging from 13 to 29). Chemotherapy included a single bonus dose of HILP with cisplatin (CDDP, 15 mg/m(2)). The plasma concentration of platin and the tumor temperature in the affected limb were measured during the course of the HILP with CDDP. Limb salvage surgery was performed in 9 patients and amputation in 6. After surgery, serial sections of the excised tumor specimens were made to determine the tumor necrosis rate. All of the patients were followed up for more than 5 years.


RESULTS
The highest attained tumor temperature was between 41.4 degrees C - 43.0 degrees C (mean 42.3 degrees C +/- 0.46 degrees C), and the platin concentration ranged from 4.56 microg/mL to 14.66 microg/mL (mean 8.93 microg/mL +/- 3.16 microg/mL) during the course of HILP with CDDP. Thirteen patients with a necrosis rate of over 90% were well responded, and the remaining two with a necrosis rate 87.2% and 86.3% were poor responded. Eight patients remained tumor-free for 5 years. Primary tumor temperature and platin concentration were significantly related to the tumor necrosis rate (P = 0.001 and P < 0.001, respectively). No significant correlation was noted between the long-term survival rate and the three parameters in the regression analysis.


CONCLUSIONS
HILP with CDDP is useful in the treatment of primary osteosarcoma. Increased tumor necrosis ensure a successful surgical excision of tumor. HILP however is still limited to the patients who are not candidates for lime salvage surgery, because the same condition of high temperature and high concentration of platin are not applicable to distant metastasis.
Fan
S
S
Department of Orthopaedics, Run Run Shaw Hospital of Zhejiang University, Hangzhou 310016, China.
Yang
D
D
Tao
H
H
Ye
Z
Z
He
R
R
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D002945:Cisplatin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D035002:Lower Extremity; D008297:Male; D009336:Necrosis; D012516:Osteosarcoma / Q000473:pathology / Q000628:therapy*
D000970:Antineoplastic Agents; D002945:Cisplatin