title: Radionuclide leakage monitoring during hyperthermic isolated limb perfusion for treatment of local melanoma metastasis in an extremity.
abstract: BACKGROUND
  The aim is to describe the importance of leakage monitoring in hyperthermic isolated limb perfusion (ILP). It is generally recommended that leakage should not exceed 10% because of risk of systemic toxicity.
  
  
  METHODS
  Data retrieved by retrospective analysis of 131 perfusions performed in 115 consecutive patients (77 women and 38 men; median age 66 years) with recurrent and/or clinically apparent, cutaneous or subcutaneous melanoma metastases in an extremity. Radionuclide monitoring was performed with continuous, precordial count rate determinations of an intravascular (99m) Tc-labelled tracer infused into the isolated limb circulation.
  
  
  RESULTS
  One hundred and sixteen of 131 procedures were completed. In 13%, a leakage of ≥10% was detected; in 6% (n = 8), the cytotoxic drug was never infused because of constant leakage; in 7% (n = 9), leakage ≥10% was measured during the perfusion resulting in two perfusions being terminated before 30 min, 5 perfusions were considered completed though with early termination (after 30 min, before 60 min), and 2 fully completed. No patients had systemic toxicity requiring treatment, whereas considerable or serious local toxicity were observed in 14%. Three of the patients with leakage ≥10% were successfully treated in a repeated procedure.
  
  
  CONCLUSIONS
  Leakage monitoring using a threshold of 10% during ILP saves the patients from systemic toxicity, however, at the expense of early termination or cancellation of ILP treatment in a few patients and repeated ILP procedures in some.
authors.affiliation: Clinic for Plastic Surgery, Burn Treatment and Breast Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Ida F
authors.initials: IF
authors.lastname: Paulsen
authors.affiliation: Melanoma Institute Australia and the University Sydney, Sydney, New South Wales, Australia.
authors.forename: Annette Hougaard
authors.initials: AH
authors.lastname: Chakera
authors.affiliation: Clinic for Plastic Surgery, Burn Treatment and Breast Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Grethe
authors.initials: G
authors.lastname: Schmidt
authors.affiliation: Clinic for Plastic Surgery, Burn Treatment and Breast Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Drejøe
authors.affiliation: Clinic for Plastic Surgery, Burn Treatment and Breast Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Klyver
authors.affiliation: Clinic for Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Oturai
authors.affiliation: Clinic for Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Birger
authors.initials: B
authors.lastname: Hesse
authors.affiliation: Clinic for Plastic Surgery, Burn Treatment and Breast Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Krystztof
authors.initials: K
authors.lastname: Drzewiecki
authors.affiliation: Clinic for Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Jann
authors.initials: J
authors.lastname: Mortensen
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects* / Q000379:methods; D016903:Drug Monitoring / Q000379:methods; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000517:prevention & control; D005121:Extremities; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects / Q000379:methods; D008297:Male; D008545:Melanoma / Q000150:complications / Q000556:secondary* / Q000628:therapy*; D011877:Radionuclide Imaging; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: TNF-alpha; chemotherapy toxicity; extremity metastasis; melphalan; regional chemotherapy