Radionuclide leakage monitoring during hyperthermic isolated limb perfusion for treatment of local melanoma metastasis in an extremity

IntroductionThe 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. Material and methodsData retrieved by retrospective analysis of 131 perfusions performed in 115 consecutive patients (77 women and 38 men; median age 66years) 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 Tc-99m-labelled tracer infused into the isolated limb circulation. ResultsOne 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 30min, 5 perfusions were considered completed though with early termination (after 30min, before 60min), 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. ConclusionLeakage 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.