Common peroneal nerve palsy following TNF-based isolated limb perfusion for irresectable extremity desmoid tumor.
Hyperthermic isolated limb perfusion (ILP) (2 mg, TNF-alpha and 100mg, melphalan) was performed for an irresectable right thigh desmoid tumor with calf extension in a 49-year-old man. The patient had a history of four resections since the age of 19 years. Local ILP toxicity appeared with extensive edema and common peroneal neurologic impairment including paresis that remained severe 10 months later. One of the most troublesome side effects of perfusion is peripheral nerve damage, which has been reported at a rate of between 1 and 48% of perfused patients. ILP is an effective treatment in recurrence situations or where resection threatens loss of function; it, however, requires administration in specialized centers, progress in standardization and close monitoring to avoid locoregional toxicity, the mechanisms of which merit further investigation. Emergency compartmental pressure measurement may indicate fasciotomy, can be of great interest.
Drouet
A
A
Neurology Department, Desgenettes Military Teaching Hospital, 108, boulevard Pinel, 69275 Lyon cedex 3, France. drouetalain@yahoo.fr
Le Moigne
F
F
Have
L
L
Blondet
R
R
Jacquin
O
O
Chauvin
F
F
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects* / Q000379:methods; D004576:Electromyography; D018222:Desmoid Tumors / Q000188:drug therapy* / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D010243:Paralysis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D010543:Peroneal Nerve / Q000187:drug effects / Q000503:physiopathology; D018570:Risk Assessment; D012720:Severity of Illness Index; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000473:pathology; D013848:Thigh; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage / Q000009:adverse effects*
D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan