Hyperthermic isolated regional perfusion of the limb with carboplatin

Aims: To investigate the feasibility of hyperthermic isolated regional perf usion (HIRP) with carboplatin in the management of locally recurrent and/or intransit metastases of melanoma or locally advanced soft tissue sarcoma. Methods: Three patients, two with locally advanced melanoma and one with a low-grade liposarcoma of the lower extremity, were treated with HIRP under mild hyperthermia (39-40 degreesC) with 125mg carboplatin/l perfused limb v olume. Results: No systemic toxicity was observed. Local toxicity consisted of pos t-perfusion oedema present in all three patients which resolved within 2 we eks. Clinically, a persistent local neuropathy was observed in all three pa tients, two of which were confirmed by electromyogram and nerve conduction study. Severe motor-sensory neuropathy was located mainly in the peroneal a nd sural nerves of the perfused limbs. Pharmacokinetic parameters of the ca rboplatin showed a higher concentration of carboplatin in the skin compared to the muscle. The two melanoma patients showed a complete response but de veloped local recurrences within 1.5 years after perfusion. The third patie nt underwent a delayed excision of the sarcoma 8 weeks after perfusion whic h revealed 50% viable tumour. One of the melanoma patients and the sarcoma patient died from lung metastases 56 and 31 months pest-perfusion treatment , respectively. The other melanoma patient is alive 95 + months post-perfus ion treatment. Conclusions: The local neurotoxicity observed did not warrant further resea rch of carboplatin in HIRP. (C) 2000 Harcourt Publishers Ltd.