Daryanani D, de Vries E G, Guchelaar H J, van Weerden T W, Hoekstra H J
Division of Surgical Oncology, University Hospital Groningen, Groningen, The Netherlands.
Eur J Surg Oncol. 2000 Dec;26(8):792-7. doi: 10.1053/ejso.2000.1006.
To investigate the feasibility of hyperthermic isolated regional perfusion (HIRP) with carboplatin in the management of locally recurrent and/or intransit metastases of melanoma or locally advanced soft tissue sarcoma.
Three patients, two with locally advanced melanoma and one with a low-grade liposarcoma of the lower extremity, were treated with HIRP under mild hyperthermia (39-40 degrees C) with 125 mg carboplatin/l perfused limb volume.
No systemic toxicity was observed. Local toxicity consisted of post-perfusion oedema present in all three patients which resolved within 2 weeks. Clinically, a persistent local neuropathy was observed in all three patients, two of which were confirmed by electromyogram and nerve conduction study. Severe motor-sensory neuropathy was located mainly in the peroneal and sural nerves of the perfused limbs. Pharmacokinetic parameters of the carboplatin showed a higher concentration of carboplatin in the skin compared to the muscle. The two melanoma patients showed a complete response but developed local recurrences within 1.5 years after perfusion. The third patient underwent a delayed excision of the sarcoma 8 weeks after perfusion which revealed 50% viable tumour. One of the melanoma patients and the sarcoma patient died from lung metastases 56 and 31 months post-perfusion treatment, respectively. The other melanoma patient is alive 95+ months post-perfusion treatment.
The local neurotoxicity observed did not warrant further research of carboplatin in HIRP.
探讨卡铂热灌注隔离区域灌注（HIRP）用于治疗黑色素瘤局部复发和/或转移灶、或局部晚期软组织肉瘤的可行性。
3例患者，2例为局部晚期黑色素瘤，1例为下肢低度脂肪肉瘤，在轻度热疗（39 - 40摄氏度）下接受HIRP治疗，每灌注肢体体积使用125毫克卡铂。
未观察到全身毒性。局部毒性表现为所有3例患者均出现灌注后水肿，2周内消退。临床上，所有3例患者均出现持续性局部神经病变，其中2例经肌电图和神经传导研究证实。严重的运动感觉神经病变主要位于灌注肢体的腓总神经和腓肠神经。卡铂的药代动力学参数显示，皮肤中的卡铂浓度高于肌肉。2例黑色素瘤患者出现完全缓解，但灌注后1.5年内出现局部复发。第3例患者在灌注8周后接受了肉瘤延迟切除术，发现50%的肿瘤仍存活。其中1例黑色素瘤患者和肉瘤患者分别在灌注治疗后56个月和31个月死于肺转移。另1例黑色素瘤患者在灌注治疗后95 +个月仍存活。
观察到的局部神经毒性不支持在HIRP中进一步研究卡铂。
