Technique (Creech et al, Os et al):
(1) High doses of chemotherapeutic agents are perfused into the affected limb using an extra-corporeal circuit.
(2) The perfusions are hyperthermic (39-40°C). The heat is intended to increase blood flow to and membrane permeability of tumor cells.
(3) After the procedure is complete, a fasciotomy may be performed to prevent a compartment syndrome.
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Toxicity
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Grade
|
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no reaction, objectively or subjectively
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I
|
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slight erythema, OR
slight edema, OR
loss of sensation
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II
|
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considerable erythema with some blistering, OR
moderate edema, OR
slight functional disturbances (includes neurotoxicity)
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III
|
|
extreme epidermolysis, OR
severe edema
obvious damage to the deep tissues, causing definite functional disturbances
|
IV
|
|
reaction that might necessitate amputation of the limb
|
V
|
after Table 1, page 1225, Hockstra et al (1993)
where:
• I am confused by Grade I. It either means that all perfusions without adverse effects are Grade I (viz there is no Grade 0), or that there is some evidence of a minimal toxicity not covered by Grade II.
• In Table 1 edema is "considerable" for Grade III and is not mentioned for Grade IV. However, in the Results section of Hockstra et al moderate and severe edema appear to be recognized.
• Neurotoxicity and loss of function seem intertwined in the table. I've handled them separately in the implementation.
