Regional chemotherapy for XXXX . A 35-year experience.

@entity1 @entity137 @entity5 @entity3 @entity320
OBJECTIVE: The authors present their 35-year experience with intra-arterial chemotherapeutic regional perfusion of 1139 @entity1 with @entity320 , using an extracorporeal oxygenated circuit and heart-lung apparatus. SUMMARY BACKGROUND DATA: Intra-arterial chemotherapy produces improved responses in many @entity5 . By isolating and sustaining the area with extracorporeal oxygenated circulation, high doses can be delivered to the @entity5 area, limited only by local @entity137 . Drug levels up to 10 times those achieved by systemic administration are obtained. METHODS: Techniques for hyperthermic perfusion were developed for limbs, pelvis, head, neck, and skin of the breast. Melphalan (Burroughs Wellcome, Research Triangle Park, NC) was used in 753 @entity1 . Combinations with melphalan or other drugs were used in remaining cases at temperature of 38 to 40 C for 30 to 60 minutes. RESULTS: Chemotherapy perfusion followed by @entity5 excision or node dissection, was performed where indicated. The cumulative 10-year survival for @entity1 with localized @entity320 was 70%. For @entity1 with local recurrences or satellites within 3 cm, survival was 61%. For those with regionally confined intransit @entity5 , survival was 30%; for those with regional node involvement, 38%; for those with intransit and nodal @entity3 , 16%; for those with distant @entity3 and perfusion--mainly to save functional limbs--survival was 7%. Multiple perfusions were performed in 158 @entity1 with recurrent disease on 366 occasions. @entity1 with indolent regionally confined @entity320 were benefited by prolongation of useful life. CONCLUSIONS: Safe perfusion techniques are available for most anatomic regions. Increased chemotherapeutic doses are delivered to isolated areas limited only by local @entity137 . Adjunct perfusion in poor prognosis stage I cases is useful in reducing local recurrence, and intransit or lymph node @entity3 . Regional perfusion reduces the need for major amputation. Multiple perfusion can be useful in treating recurrent chronic @entity320 .
