Abstract
During isolated limb perfusion, we studied the impact of limb temperature on the concentration of cytostatic drugs in the tissue to identify a possible selective absorption of cytostatic agents by the various tissues. Ten consecutive patients with malignant melanoma were randomly divided into two different groups and perfused with 1 mg cisplatin per kg body weight. In one group the cytostatic agents were injected under hyperthermic conditions (39.5°C) and in the other group under normothermic conditions (37°C). The platinum concentration in the melanoma was twice as high in the hyperthermic group as in the group under normothermic conditions. In the tumor-free tissue the platinum concentration decreased with temperature while it remained constant in the musculature. This selective concentration of cisplatin in the tumor under hyperthermic conditions is accompanied by fewer side effects. Follow-up will show whether the oncological results will be improved in the hyperthermic conditions as one might expect.
Résumé
Nous avons mésuré l'impacte de la température ambiante sur la concentration tissulaire en platinum au moment de son injection afin d'identifier une absorption sélective des drogues cytostatiques par les tissues pendant la perfusion isolée des extrémités. Dix patients consécutifs ayant un mélanome malin ont été randomisés pour recevoir une perfusion de cisplatine (1 mg par kg de poids corporel) soit à 39.5°C, soit à 37.0°C. Les concentrations de platinium étaient deux fois plus importantes dans le mélanome du groupe hyperthermique que dans celui du groupe normothermique. Dans les tissus non-tumoraux, les concentrations étaient proportionnellement plus basses, alors que dans les muscles, les concentrations étaient constantes. Cette sélectivité de concentration de cisplatine s'accompagne de moins d'effets secondaires. Il faut attendre l'évolution à plus long terme pour juger des résultats au plan oncologique.
Resumen
Hemos estudiado el impacto de la temperatura del miembro en el momento de la inyección de drogas citostásicas midiendo la concentración tisular de platino, con el propósito de identificar una posible absorción selectiva de los agentes cistotásicos por los diferentes tejidos durante la perfusión aislada de una extremidad. Se asignaron, en forma randomizada, 10 pacientes consecutivos con melanoma maligno a dos grupos diferentes que fureon perfundidos con cisplatino 1 mg por 1 kg de peso corporal. En uno de los grupos los agentes citotóxicos fureon inyectados bajo condiciones de hipertermia (39.5°C). La concentración de platino en el menaloma apareció dos veces más alta en el grupo de perfusión hipertérmica que en el grupo normotérmico (37°C). En los tejidos libres de tumor la concentración de platino disminuyó con la temperatura, en tanto que permaneció constante en la masa muscular. Tal concentración selectiva del cisplatino en el tumor bajo condiciones hipertérmicas está acompanada de menos efectos secundarios. El seguimiento habrá de demostrar si los resultados oncológicos son mejores de lo que se pueda esperar.
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Omlor, G., Gross, G., Ecker, K.W. et al. Optimization of isolated hyperthermic limb perfusion. World J. Surg. 16, 1117–1119 (1992). https://doi.org/10.1007/BF02067073
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DOI: https://doi.org/10.1007/BF02067073