Indocyanine Green for Leakage Control in Isolated Limb Perfusion

Sarcomas are characterized by a high metastatic potential and aggressive growth. Despite surgery, chemotherapy plays an important role in the treatment of these tumors. Optimal anti-cancer therapy with maximized local efficacy and minimized systemic side effects has been the object of many studies for a long time. To improve the local efficacy of anti-tumor therapy, isolated limb perfusion with high-dose cytostatic agents has been introduced in surgical oncology. In order to control the local distribution of substances, radiolabeled cytostatic drugs or perfusion solutions have been applied but often require the presence of specialized personnel and result in a certain exposure to radiation. In this study, we present a novel strategy using indocyanine green to track tumor perfusion with high-dose cytostatic therapy. In a rat cadaver model, the femoral vessels were cannulated and connected to a peristaltic pump to provide circulation within the selected limb. The perfusion solution contained indocyanine green and high-dose doxorubicin. An infrared camera enabled the visualization of indocyanine green during limb perfusion, and subsequent leakage control was successfully performed. Histologic analysis of sections derived proximally from the injection site excluded systemic drug dispersion. In this study, the application of indocyanine green was proven to be a safe and cost- and time-efficient method for precise leakage control in isolated limb perfusion with a high-dose cytostatic agent.

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HLA-A2 restricted CTL responses to melanocyte differentiation antigens in melanoma patients subjected to high-dose TNF-α administered by isolated limb perfusion

Melanoma Research ◽

10.1097/00008390-199509001-00048 ◽

1995 ◽

Vol 5 ◽

pp. 30

Author(s):

P. Romero ◽

S. De Souza ◽

D. Rimoldi ◽

D. Liénard ◽

J. -C. Cerottini ◽

...

Keyword(s):

Isolated Limb Perfusion ◽

High Dose ◽

Differentiation Antigens ◽

Limb Perfusion ◽

Tnf Α ◽

Melanoma Patients ◽

Ctl Responses

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A sequential isolated limb perfusion (ILP) schedule using high-dose hyperthermia and melphalan results in a high complete response rate

Inpharma Weekly ◽

10.2165/00128413-200314040-00035 ◽

2003 ◽

Vol &NA; (1404) ◽

pp. 17

Author(s):

&NA;

Keyword(s):

Response Rate ◽

Complete Response Rate ◽

Complete Response ◽

Isolated Limb Perfusion ◽

High Dose ◽

Limb Perfusion

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Isolated limb perfusion for soft-tissue sarcoma and regional melanoma.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.10579 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 10579-10579

Author(s):

Olfa Derbel ◽

Eve-Marie Neidhardt ◽

Adeline Stoltz ◽

Pierre Meeus ◽

Aurelien Dupre ◽

...

Keyword(s):

Partial Response ◽

Limb Salvage ◽

Response Rate ◽

Complete Response ◽

Isolated Limb Perfusion ◽

High Dose ◽

Limb Salvage Rate ◽

Limb Perfusion ◽

Melanoma Patients ◽

Salvage Rate

10579 Background: Isolated limb perfusion (ILP) represents a treatment option for locally advanced melanoma and sarcoma confined to a limb. The advantage of this approach is to deliver high-dose regional chemotherapy without serious systemic effects. However, the ILP technique involves a complex and invasive operative procedure, requiring accurate monitoring to avoid major local toxicity. Methods: From November 2004 to December 2011, 58 patients underwent IPL for unresectable soft tissu sarcoma (STS= 34) and advanced in-transit melanoma (n=24). IPLs were performed at mild hyperthermic conditions with 1-2 mg of TNF and 40-80 mg of melphalan (M) for arm and leg perfusions, respectively. The response rate, disease free intervals, overall survival, toxicity and limb salvage rate were evaluated. Results: Median age was 68 years (range: 29-91 years), with 58% of women. For sarcoma patients, median tumor size was 60 mm, 16 patients (47%) had a high grade STS. Twenty-one patients (61%) received IPL before definitive surgery. Eight patients finally underwent amputation, giving a long-term limb salvage of 77%. The overall response rate was 73.5% (Complete response rate 14.7%, partial response rate 58.8 %). For melanoma patients, 9 (38%) had an AJCC stage III disease, the median thickness of the primary tumor was 3.5 mm. A complete response was obtained in 21% of patients while 54% exhibited a partial response. The local and metastatic recurrence rates were similar between sarcoma and melanoma patients (41% and 33% respectively). All but one of the patients with non-operated sarcoma presented a local or metastatic relapse.There was no mortality and no systemic toxicity. Regional toxicity (Wieberdink scale) was: grade I (no reaction) 53 %, II (erythema, oedema) 34%, III (blistering) 8% and IV 3%. The median local relapse-free survival was 40 months in sarcoma group (26.6 months for non operated patients) and 10 months in melanoma one. The overall 3-years survival rate was 44% for sarcoma and 25% for melanoma patients. Conclusions: ILP induces a high tumour response rate, leads to a high limb salvage rate but is associated with an important recurrence rate. It provides a limb salvage alternative to amputation when local control is necessary.

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