PMID- 11986187
OWN - NLM
STAT- MEDLINE
DCOM- 20020717
LR  - 20190922
IS  - 1068-9265 (Print)
IS  - 1068-9265 (Linking)
VI  - 9
IP  - 4
DP  - 2002 May
TI  - 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.
PG  - 355-63
AB  - 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 < or = 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.
FAU - van Ginkel, Robert J
AU  - van Ginkel RJ
AD  - Department of Surgical Oncology, Groningen University Hospital, Groningen, The 
      Netherlands.
FAU - Limburg, Pieter C
AU  - Limburg PC
FAU - Piers, D Albertus
AU  - Piers DA
FAU - Koops, Heimen Schraffordt
AU  - Koops HS
FAU - Hoekstra, Harald J
AU  - Hoekstra HJ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Ann Surg Oncol
JT  - Annals of surgical oncology
JID - 9420840
RN  - 0 (Antineoplastic Agents, Alkylating)
RN  - 0 (Iodine Radioisotopes)
RN  - 0 (Organotechnetium Compounds)
RN  - 0 (Radiopharmaceuticals)
RN  - 0 (Serum Albumin)
RN  - 0 (Tumor Necrosis Factor-alpha)
RN  - 0 (technetium Tc 99m serum albumin)
RN  - Q41OR9510P (Melphalan)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Antineoplastic Agents, Alkylating/blood
MH  - Area Under Curve
MH  - Chemotherapy, Cancer, Regional Perfusion/*methods
MH  - Extremities
MH  - Female
MH  - Humans
MH  - *Hypothermia, Induced
MH  - *Iodine Radioisotopes
MH  - Male
MH  - Melanoma/blood/*drug therapy
MH  - Melphalan/blood/*therapeutic use
MH  - Middle Aged
MH  - Monitoring, Physiologic/*methods
MH  - *Organotechnetium Compounds
MH  - *Radiopharmaceuticals
MH  - Sarcoma/blood/*drug therapy
MH  - *Serum Albumin
MH  - Skin Neoplasms/blood/*drug therapy
MH  - Soft Tissue Neoplasms/blood/*drug therapy
MH  - Treatment Outcome
MH  - Tumor Necrosis Factor-alpha/analysis/*therapeutic use
EDAT- 2002/05/03 10:00
MHDA- 2002/07/18 10:01
CRDT- 2002/05/03 10:00
PHST- 2002/05/03 10:00 [pubmed]
PHST- 2002/07/18 10:01 [medline]
PHST- 2002/05/03 10:00 [entrez]
AID - 10.1007/BF02573870 [doi]
PST - ppublish
SO  - Ann Surg Oncol. 2002 May;9(4):355-63. doi: 10.1007/BF02573870.