Annals of Surgical Oncology Cite Track
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by van Ginkel, R. J.
Right arrow Articles by Hoekstra, H. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by van Ginkel, R. J.
Right arrow Articles by Hoekstra, H. J.
Annals of Surgical Oncology 9:355-363 (2002)
© 2002 Society of Surgical Oncology

ORIGINAL ARTICLES

Value of Continuous Leakage Monitoring With Radioactive Iodine-131–Labeled Human Serum Albumin During Hyperthermic Isolated Limb Perfusion With Tumor Necrosis Factor-{alpha} and Melphalan

Robert J. van Ginkel, MD, Pieter C. Limburg, PhD, D. Albertus Piers, MD, PhD, Heimen Schraffordt Koops, MD, PhD and Harald J. Hoekstra, MD, PhD

From the Departments of Surgical Oncology (RJVG, HSK, HJH), Internal Medicine (PCL), and Nuclear Medicine (DAP), Groningen University Hospital, Groningen, the Netherlands.

Correspondence: Address correspondence and reprint requests to: Harald J. Hoekstra, MD, PhD, Department of Surgery, Division of Surgical Oncology, Groningen University Hospital, PO Box 30.001, 9700 RB Groningen, the Netherlands; Fax: 0031-503614873; E-mail: h.j.hoekstra@ chir.azg.nl.

Background: The aim of this study was to analyze the value of continuous leakage monitoring with radioactive iodine-131–labeled human serum albumin (RISA) in patients treated with hyperthermic isolated limb perfusion with tumor necrosis factor-{alpha} (TNF{alpha}) and melphalan.

Methods: Forty-eight patients with melanoma (n = 14) or soft tissue sarcoma (n = 34) of an extremity underwent 51 perfusions. Perfusion was performed at the iliac level in 22 cases, at the popliteal level in 16 cases, at the femoral level in 7 cases, and at the axillary level in 6 cases. Leakage rates and perfusion circuit and systemic levels of TNF{alpha}, interleukin-6, and C-reactive protein were determined, as were systemic hematological and metabolic profiles and tumor response.

Results: The mean isotopically measured leakage was 2.9%. Systemic leakage was <=2% in 28 perfusions and >2% in 23 perfusions. The correlation between the maximal monitored leakage and maximal systemic TNF{alpha} levels was .7114. The area under the curve for TNF{alpha} in the perfusion circuit, indicating the exposure of the perfused limb to TNF{alpha}, was 18.7% lower in the >2% leakage group. No significant differences in tumor response were found between groups. The area under the curve for systemic TNF{alpha}, indicating the exposure of the patient to TNF{alpha}, was 18.1 times higher in the >2% leakage group, resulting in a significant decrease in leukocyte and platelet count, hyperbilirubinemia, hypocholesterolemia, and proteinemia. No beneficial effect of the systemically leaked TNF and melphalan was seen on the occurrence of distant metastasis during follow-up. There was a significant difference between perfusions performed at the iliac and femoral levels compared with leakage values at the popliteal level.

Conclusions: A good correlation between RISA leakage measurement and TNF{alpha} exposure during and after hyperthermic isolated limb perfusion with TNF{alpha} and melphalan was demonstrated. RISA leakage measurement serves as a good guide for the effectiveness of isolation during perfusion. If leakage exceeds the 2% limit during perfusion, less exposure of the tumor-bearing limb to TNF{alpha}, increased exposure of the patient systemic circulation to TNF{alpha}, and more systemic side effects can be expected.

Key Words: Hyperthermic isolated limb perfusion • Leakage • Iodine-131–labeled human serum albumin • Sarcoma • Melanoma • Tumor necrosis factor-{alpha}




This article has been cited by other articles:


Home page
 Ann. Surg. Oncol.Home page
M. L. Hoven-Gondrie, K. M. J. Thijssens, J. H. B. Geertzen, E. Pras, R. J. van Ginkel, and H. J. Hoekstra
Isolated Limb Perfusion and External Beam Radiotherapy for Soft Tissue Sarcomas of the Extremity: Long-Term Effects on Normal Tissue According to the LENT-SOMA Scoring System
Ann. Surg. Oncol., May 1, 2008; 15(5): 1502 - 1510.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
M. L. Hoven-Gondrie, K. M. J. Thijssens, J. J. A. M. Van den Dungen, J. Loonstra, R. J. van Ginkel, and H. J. Hoekstra
Long-Term Locoregional Vascular Morbidity After Isolated Limb Perfusion and External-Beam Radiotherapy for Soft Tissue Sarcoma of the Extremity
Ann. Surg. Oncol., July 1, 2007; 14(7): 2105 - 2112.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
R. J. van Ginkel, K. M. J. Thijssens, E. Pras, W. T. A. Van der Graaf, A. J. H. Suurmeijer, and H. J. Hoekstra
Isolated Limb Perfusion with Tumor Necrosis Factor Alpha and Melphalan for Locally Advanced Soft Tissue Sarcoma: Three Time Periods at Risk for Amputation
Ann. Surg. Oncol., April 1, 2007; 14(4): 1499 - 1506.
[Abstract] [Full Text] [PDF]

Home page
 Ann OncolHome page
S. Bonvalot, A. Laplanche, F. Lejeune, E. Stoeckle, C. Le Pechoux, D. Vanel, P. Terrier, J. Lumbroso, M. Ricard, G. Antoni, et al.
Limb salvage with isolated perfusion for soft tissue sarcoma: could less TNF-{alpha} be better?
Ann. Onc., July 1, 2005; 16(7): 1061 - 1068.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2002 by the Society of Surgical Oncology.