title: Isolated limb perfusion with hyperthermia and chemotherapy: predictive factors for regional toxicity.
abstract: OBJECTIVE
  Isolated limb perfusion combined with melphalan is an accepted treatment for obtaining locoregional control in advanced melanoma of the extremities and other malignant neoplasias restricted to the limb. This study aims to examine the factors associated with toxicity caused by the regional method. We considered the technical aspects of severe complications associated with the procedure in an attempt to diminish the patient morbidity that occurs during the learning curve.
  
  
  METHODS
  We conducted a retrospective analysis of the records of patients who underwent perfusion at the AC Camargo Hospital in São Paulo, Brazil between January 2000 and January 2009. The Wieberdink scale was applied to classify local toxicity and its relation to clinical and laboratory variables.
  
  
  RESULTS
  Fifty-eight perfusions were performed in 55 patients. Most patients (86.2%) presented a toxicity level between I and III. Grade V toxicity was seen in five cases (8.6%), four of which occurred in the first 2 years. Creatine phosphokinase, an important predictive factor for toxicity, had an average value of 231.8 for toxicity grades I-III and 1286.2 for toxicity grades IV-V (p = 0.001). There was a relationship between the melphalan dose and toxicity, which was 77 mg (25 to 130 mg) for toxicity grades I-II and 93.5 mg (45 to 120 mg) for toxicity grades IV-V (p = 0.0204).
  
  
  CONCLUSIONS
  It is possible to prevent the toxicity associated with melphalan by adjusting the dose according to the patient's body weight (especially for women and obese patients) and the creatine phosphokinase values in the postoperative period.
authors.affiliation: Hospital do Câncer AC Camargo, São Paulo, SP, Brazil. jduprat@uol.com.br
authors.forename: João Pedreira
authors.initials: JP
authors.lastname: Duprat Neto
authors.forename: Fernanda
authors.initials: F
authors.lastname: Oliveira
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bertolli
authors.forename: Andre Sapata
authors.initials: AS
authors.lastname: Molina
authors.forename: Kenji
authors.initials: K
authors.lastname: Nishinari
authors.forename: Luciana
authors.initials: L
authors.lastname: Facure
authors.forename: Jose Humberto
authors.initials: JH
authors.lastname: Fregnani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001835:Body Weight / Q000502:physiology*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects* / Q000379:methods; D003402:Creatine Kinase / Q000097:blood; D054796:Drug Dosage Calculations; D005260:Female; D006801:Humans; D007866:Leg; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000201:enzymology; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000201:enzymology; D018709:Statistics, Nonparametric; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003402:Creatine Kinase; D008558:Melphalan