Hyperthermic isolated limb perfusion combined with tasonermin - A perfusion deakage monitoring technique

Abstract

Background: Hyperthermic isolated limb perfusion is used to treat irresectable extremity malignancies. It is based on the following principle -The perfusion of the extremity is isolated from systemic circulation and connected to an extra-corporal circuit via which a very high concentration of a chemotherapeutic agent is administered into the blood compartment of the extremity. In some cases, treatment efficiency can be improved using tasonermin (a TNF-A agent). By itself, tasonermin can cause severe health complications in patients if leakage into systemic circulation re-sults in a level that exceeds the maximally tolerated dose. Therefore, it is important to monitor for leakage during the whole operation. Method: Leakage monitoring was performed by a nuclear medicine method based on the measurement of activity of a gamma-emitting radiotracer detected by a scintillation probe located over the heart An amount of radiotracer that resulted in a basal level of measured signal was first administered into the systemic circuit followed by the administration of a second, one order of magnitude higher amount of radiotracer into the per-fusion circuit Leakage, when it occurred, increased the count rate detected over the heart, and the mathematical relation between leakage level and count rate increase was derived. Results: In our department, the method was tested and optimized during isolated limb perfusion without using a TNF-A agent. Then, accreditation for the use of TNF-A was granted. Since then, the method has been used to monitor leakage in all cases of isolated limb perfusion with TNF-A All isolated limb perfusion operations with TNF-A passed without complications. The radiation burden was almost negligible for both the patient and medical staff. Conclusion: The method described in this report represents a reliable method for perfusion leakage monitoring when using TNF-A in our department.