title: Calculating regional tissue volume for hyperthermic isolated limb perfusion: Four methods compared.
abstract: BACKGROUND
  Hyperthermic isolated limb perfusion (HILP) can be performed as an alternative to amputation for soft tissue sarcomas and melanomas of the extremities. Melphalan and tumor necrosis factor-alpha are used at a dosage that depends on the volume of the limb. Regional tissue volume is traditionally measured for the purposes of HILP using water displacement volumetry (WDV). Although this technique is considered the gold standard, it is time-consuming and complicated to implement, especially in obese and elderly patients.
  
  
  OBJECTIVE
  The aim of the present study was to compare the different methods described in the literature for calculating regional tissue volume in the HILP setting, and to validate an open source software.
  
  
  METHODS
  We reviewed the charts of 22 patients (11 males and 11 females) who had non-disseminated melanoma with in-transit metastases or sarcoma of the lower limb. We calculated the volume of the limb using four different methods: WDV, tape measurements and segmentation of computed tomography images using Osirix and Oncentra Masterplan softwares.
  
  
  CONCLUSIONS
  The overall comparison provided a concordance correlation coefficient (CCC) of 0.92 for the calculations of whole limb volume. In particular, when Osirix was compared with Oncentra (validated for volume measures and used in radiotherapy), the concordance was near-perfect for the calculation of the whole limb volume (CCC = 0.99). With methods based on CT the user can choose a reliable plane for segmentation purposes. CT-based methods also provides the opportunity to separate the whole limb volume into defined tissue volumes (cortical bone, fat and water).
authors.affiliation: Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital of Padova, Italy. Electronic address: diego.cecchin@unipd.it.
authors.forename: D
authors.initials: D
authors.lastname: Cecchin
authors.affiliation: Medical Physics Unit, Veneto Institute of Oncology IOV-IRCCS, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Negri
authors.affiliation: Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital of Padova, Italy.
authors.forename: A C
authors.initials: AC
authors.lastname: Frigo
authors.affiliation: Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital of Padova, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bui
authors.affiliation: Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital of Padova, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Zucchetta
authors.affiliation: Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital of Padova, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Bodanza
authors.affiliation: Radiotherapy Unit, Veneto Institute of Oncology IOV-IRCCS, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Gregianin
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Italy.
authors.forename: L G
authors.initials: LG
authors.lastname: Campana
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Italy.
authors.forename: C R
authors.initials: CR
authors.lastname: Rossi
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Rastrelli
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D054796:Drug Dosage Calculations; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D007091:Image Processing, Computer-Assisted; D035002:Lower Extremity / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000628:therapy*; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009929:Organ Size; D000072078:Positron Emission Tomography Computed Tomography; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage
chemical_list: D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan
keywords: Hyperthermic isolated limb perfusion; Melanoma; PET/CT; Volume calculation