CARDIAC AND PULMONARY EFFECTS OF ALPHA-TUMOR-NECROSIS-FACTOR ADMINISTERED BY ISOLATION PERFUSION

Aims We studied cardiac and pulmunary function in 22 patients affected by in transit metastases from cutaneous melanoma and metastases from soft tissue sarcoma of the limbs and treated with isolation perfusion in extracorporeal circulation with rTNF alpha at doses ranging from 0. 5 to 4 mg/m(2) in mild hyperthermia. Patients and methods: All patient s experienced a septic-like shock syndrome of variable severity: this feature lasted from 24 to 72 h and was controlled by the infusion of d opamine. Seventeen patients suffered from respiratory insufficiency, w hich required assisted ventilation (7 cases mechanical ventilation for 1 day, 8 cases for 2 days, and 2 cases synchronized intermittent mand atory ventilation). Results: Spirometric parameters recorded 7-15 days after treatment did not change from baseline values. In contrast, lun g transfer factor for carbon monoxide significantly declined in a dose dependent fashion. Conclusions: Our data confirm that rTNF alpha admi nistered by isolation perfusion technique induces systemic cardiovascu lar and pulmonary side effects. Further studies are required to better define time course and reversibility of impaired pulmunary function.