A clinical and pharmacokinetic study of isolated limb perfusion with heat and melphalan for XXXX .

@entity1 @entity137 @entity4 @entity16 @entity3601 @entity1431 @entity941 @entity320
The pharmacokinetics of isolated limb perfusion were studied to see what melphalan concentrations were achieved and how effective the isolation was. Twenty-eight @entity1 received 32 limb perfusions with heat and melphalan for locally recurrent or level V @entity320 . Melphalan was given 0.75 mg/kg for axillary/popliteal or 1.2 mg/kg for femoral perfusions with heat (perfusate 42 degrees C, limb 40 degrees C) for 1 hour. @entity3601 concentratives were measured by high-performance liquid chromatography in seven @entity1 . Peak perfusate melphalan concentrations were 6.1 to 115 mg/ml, which was one to two logs higher than peak systemic concentratives of melphalan. Isolation of the perfusate circuit from the systemic circulation was better for axillary and popliteal perfusions than for femoral perfusions (P less than 0.05). Complete responses were seen in 81% of evaluable @entity1 ; long-term local control was achieved in most @entity1 , although many developed hematogenous metastases. @entity137 included erythema and @entity4 in all, mild @entity1431 in two, @entity16 in two, and amputation was required in one @entity1 . Improvements in surgical technique include regional anesthesia to reduce vasospasms and transcutaneous measurement of @entity941 to measure leak. Perfusion with heat and melphalan remains the treatment of choice for in-transit metastases from @entity320 .
