covid
Buscar en
Revista Colombiana de Cancerología
Toda la web
Inicio Revista Colombiana de Cancerología Perfusión aislada de extremidades. Experiencia inicial del Instituto Nacional d...
Información de la revista
Vol. 15. Núm. 2.
Páginas 67-74 (enero 2010)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 15. Núm. 2.
Páginas 67-74 (enero 2010)
Acceso a texto completo
Perfusión aislada de extremidades. Experiencia inicial del Instituto Nacional de Cancerología, 2007–2008
Isolated Limb Perfusion. Initial Experience at the National Cancer Institute of Colombia, 2007-2008
Visitas
4742
Carlos Duarte1,
Autor para correspondencia
carlosdu@cable.net.co

Correspondencia Carlos Duarte. Servicio de Cirugía Oncológica, Instituto Nacional de Cancerología. Av. 1a No. 9-85, Bogotá, Colombia. Tel.:éfono: 334 1111, ext. 5610.
, Mauricio García1, Carlos Lehmann2, Ricardo Sánchez3, Jorge Manrique3
1 Grupo de Cirugía Oncológica, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
2 Grupo de Cirugía de Seno y Tejidos Blandos, Instituto Nacional de Cancerología, Bogotá D.C.,Colombia
3 Grupo de Investigación Clínica, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
Este artículo ha recibido
Información del artículo
Resumen
Objetivo

Presentar la experiencia inicial del Instituto Nacional de Cancerología con la aplicación de la técnica de perfusión aislada de extremidades.

Métodos

Se recolectaron 13 pacientes desde el 2007 hasta el 2008 y se documentó tanto su patología como su respuesta a la intervención.

Resultados

El salvamento de la extremidad fue del 76%, y las complicaciones locales, del 16%. Cinco pacientes (41,7%) presentaron repuesta parcial; otros cinco (41,7%), presentaron enfermedad estable, y dos más, (16,7%) progresión de enfermedad. No hubo pacientes con respuesta clínica completa.

Conclusiones

La perfusión aislada de extremidades es una buena alternativa de tratamiento en los pacientes con melanoma y sarcomas avanzados de las extremidades con indicación de amputación para lograr conservar la extremidad. Dado el número de pacientes presentado en este artículo, y con el fin lograr conclusiones más sólidas, es necesario realizar un seguimiento cuidadoso de los pacientes, planteando un trabajo de investigación prospectivo que tenga como resultados finales el tipo de respuesta, el tiempo libre de enfermedad, la supervivencia global y las escalas de calidad de vida para los pacientes que reciben esta terapia.

Palabras clave:
Quimioterapia del cáncer por perfusión regional
sarcoma
melanoma
salvamento de extremidad
Abstract
Objective

To describe the initial experience of isolated limb perfusion at the National Cancer Institute.

Methods

Pathology and response to intervention was documented in the cases of 13 patients taken from years 2007 to 2008.

Results

Limb salvage was 76%; local complications, 16%. Five patients (41.7%) had partial response; two more (16.7%), disease progression. No patients had complete clinical response.

Conclusions

Isolated limb perfusion provides a good alternative for treating melanoma and advanced sarcomas in limbs; possibly sparing them from amputation. Due to the number of patients included in this article, and to the need to establish more solid conclusions, it is necessary to carry out closer patient follow-up by setting up a prospective research project whose results will establish type of response, disease free interval, overall survival and a quality-of-life scale for patients who receive this kind of treatment.

Key words:
Chemotherapy
neoplams
regional perfusion
sarcomas
melanoma
limb salvage
El Texto completo está disponible en PDF
Referencias
[1.]
C.E. Ariyan, M.S. Brady.
History of regional chemotherapy for cancer of the extremities.
Int J Hyperthermia, 24 (2008), pp. 185-192
[2.]
Ch. Kettelhack, T. Kraus, T. Hupp.
Hyperthermic limb perfusion for malignant melanoma and soft tissue sarcoma.
Eur J Surg Oncol, 16 (1990), pp. 370-375
[3.]
D. Liénard, A.M. Eggermont, B.B. Kroon, et al.
Isolated limb perfusion in primary and recurrent melanoma: indications and results.
Semin Surg Oncol, 14 (1998), pp. 202-209
[4.]
Instituto Nacional de Cancerología (INC)-Ministerio de la Protección Social(MPS) (Colombia).
Anuario estadístico 2007.
INC-MPS, (2008),
[5.]
O. Creech, E.T. Krementz, R.F. Ryan, et al.
Chemotherapy of cancer: regional perfusion utilizing an extracorporeal circuit.
Ann Surg, 148 (1958), pp. 616-632
[6.]
O. Creech, E.T. Krementz, R.F. Ryan, et al.
Experiences with isolation-perfusion technics in the treatment of cancer.
Ann Surg, 149 (1959), pp. 627-639
[7.]
J. Wieberdink, C. Benkuizen, R.P. Braat, et al.
Dosimetry in isolated perfusion of the limbs assessment of perfused tissue volume and grading of toxic reactions.
Eur J Cancer Clin Oncol, 18 (1982), pp. 905-950
[8.]
A.M. Eggermont, J.H. de Wilt, T.L. ten Hagen.
Current uses of isolated limb perfusion in the clinic and a model system for new strategies.
Lancet Oncol, 4 (2003), pp. 429-437
[9.]
J.F. Thompson, P.D. Good, P.C.A. Kam.
Hyperthermic isolated limb perfusion in the treatment of melanoma: technical aspects.
Reg Cancer Treat, 7 (1994), pp. 147-154
[10.]
E.T. Krementz, C.M. Sutherland, J.H. Muchmore.
Isolated hyperthermia chemotherapy perfusion for limb melanoma.
Surg Clin North Am, 76 (1996), pp. 1313-1330
[11.]
P. Therase, S. Arbuck, E. Eisenhauer, et al.
New guideline to evaluate the response to treatment in solid tumors.
J Natl Cancer Inst, 92 (2000), pp. 205-216
[12.]
E.A. Eisenhauer, P. Therasse, J. Bogaerts, et al.
New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1).
Eur J Cancer, 45 (2009), pp. 228-247
[13.]
C. Klopp, T.C. Alford, J. Bateman, et al.
Fractionated intra-arterial cancer chemotherapy with methyl bis-amine hydrochloride; a preliminary report.
Ann Surg, 132 (1950), pp. 811-832
[14.]
O.J. Creech, R. Ryan, A. Krementz.
Treatment of malignant melanoma by isolated perfusion technique.
JAMA, 169 (1959), pp. 339-343
[15.]
R. Cavaliere, E.C. Ciocatto, B.C. Giovanella, et al.
Selective heat sensitivity of cancer cells. Biochemical and clinical studies.
Cancer, 20 (1967), pp. 1351-1381
[16.]
J.S. Stehlin Jr., B.C. Giovanella, P.D. de Ipolyi, et al.
Results of hyperthermic perfusion for melanoma of the extremities.
Surg Gynecol Obstet, 140 (1975), pp. 339-348
[17.]
F.M. Golomb, A.H. Postel, A.B. Hall, et al.
Chemotherapy of human cancer by regional perfusion. Report of 52 perfusions.
Cancer, 15 (1962), pp. 828-845
[18.]
W.G. Austen, A.P. Monaco, G.S. Richardson, et al.
Treatment of malignant pelvic tumors by extracorporeal perfusion with chemotherapeutic agents.
N Engl J Med, 261 (1959), pp. 1037-1045
[19.]
R.H. Jesse.
Technique of perfusion and infusion of head and neck.
Cancer Chemother Rep, 10 (1960), pp. 21-22
[20.]
D. Lienard, P. Ewalenko, J.J. Delmotte, et al.
High-dose recombinant tumor necrosis factor alpha in combination with interferon gamma and melphalan in isolation perfusion of the limbs for melanoma and sarcoma.
J Clin Oncol, 10 (1992), pp. 52-60
[21.]
A.M. Eggermont, H. Schraffordt Koops, D. Liénard, et al.
Isolated limb perfusion with highdose tumor necrosis factoralpha in combination with interferon-gamma and melphalan for nonresectable extremity soft tissue sarcomas: a multicenter trial.
J Clin Oncol, 14 (1996), pp. 2653-2665
[22.]
A.M. Eggermont, H. Schraffordt Koops, J.M. Klausner, et al.
Isolated limb perfusion with tumor necrosis factor and melphalan for limb salvage in 186 patients with locally advanced soft tissue extremity sarcomas. The cumulative multicenter European experience.
Ann Surg, 224 (1996), pp. 756-764
[23.]
A.M. Eggermont, H. Schraffordt Koops, J.M. Klausner, et al.
Limb salvage by isolated perfusion with tumor necrosis factor alpha and melphalan for locally advanced extremity soft tissue sarcomas: result of 270 perfusions in 247 patients.
J Clin Oncol, 11 (1999), pp. 497
[24.]
F.J. Lejeune, N. Pujol, D. Liénard, et al.
Limb salvage by neoadjuvant isolated perfusion with TNFalpha and melphalan for nonresectable soft tissue sarcoma of the extremities.
Eur J Surg Oncol, 26 (2000), pp. 669-678
[25.]
E. Calvo Aller, R. Arcas Meca, A. Crespo de la Jara, et al.
Perfusión de extremidad aislada en Oncología.
Rev Oncol, 5 (2003), pp. 128-138
[26.]
D.L. Fraker.
Management of in-transit melanoma of the extremity with isolated limb perfusion.
Curr Treat Options Oncol, 5 (2004), pp. 173-184
[27.]
J.P. Duprat, A.L. Domingues, E.G. Coelho, et al.
Long-term response of isolated limb perfusion with hyperthermia and chemotherapy for Merkel cell carcinoma.
Eur J Surg Oncol, 35 (2009), pp. 568-572
[28.]
A.F. Olieman, D. Liénard, A.M. Eggermont, et al.
Hyperthermic isolated limb perfusion with tumor necrosis factor alpha, interferon gamma, and melphalan for locally advanced nonmelanoma skin tumors of the extremities: a multicenter study.
Arch Surg, 134 (1999), pp. 303-307
[29.]
S. Koops, M. Vaglini, S. Suciu, et al.
Prophylactic isolated limb perfusion for localized, high-risk limb melanoma: results of a multicenter randomized phase III trial.
J Clin Oncol, 16 (1998), pp. 2906-2912
[30.]
L. Hafström, C.M. Rudenstam, E. Blomquist, Swedish Melanoma Study Group, et al.
Regional hyperthermic perfusion with melphalan after surgery for recurrent malignant melanoma of the extremities.
J Clin Oncol, 9 (1991), pp. 2091-2094
[31.]
D.J. Grünhagen, F. Brunstein, W.J. Graveland, et al.
Isolated limb perfusion with tumor necrosis factor and melphalan prevents amputation in patients with multiple sarcomas in arm or leg.
Ann Surg Oncol, 12 (2005), pp. 473-479
[32.]
W.R. Cornett, L.M. McCall, R.P. Petersen, et al.
Randomized multicenter trial of hyperthermic isolated limb perfusion with melphalan alone compared with melphalan plus tumor necrosis factor: American College of Surgeons Oncology Group Trial Z0020.
J Clin Oncol, 24 (2006), pp. 4196-4201
[33.]
B.B. Kroon, E. Noorda, B.C. Vrouenraets, et al.
Isolated limb perfusion for melanoma.
Surg Oncol Clin N Am, 17 (2008), pp. 785-794
[34.]
D. Moreno Ramirez, L. de la Cruz Merino, L. Ferrándiz Pulido, et al.
Perfusión de miembro aislado en el tratamiento del melanoma y del sarcoma de partes blandas. [Isolated limb perfusion for locally advanced melanoma and soft tissue sarcoma: executive summary].
Ministerio de Ciencia e Innovación, (2007),
[35.]
R.H. Blum, J. Edmonson, L. Ryan, The Eastern Cooperative Oncology Group, et al.
Efficacy of ifosfamide in combination with doxorubicin for the treatment of metastatic soft-tissue sarcoma.
Cancer Chemother Pharmacol, 31 (1993), pp. S238-S240
[36.]
K. Antman, J. Crowley, S.P. Balcerzak, et al.
An intergroup phase III randomized study of doxorubicin and dacarbazine with or without ifosfamide and mesna in advanced soft tissue and bone sarcomas.
J Clin Oncol, 11 (1993), pp. 1276-1285
Copyright © 2011. Instituto Nacional de Cancerología
Descargar PDF
Opciones de artículo