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The Influence of Acute Regional Toxic Reactions

Bart C. Vrouenraets, MD; Joost M. Klaase, MD, PhD; Bin B. R. Kroon, MD, PhD; Bert N. van Geel, MD, PhD; Alexander M. M. Eggermont, MD, PhD; Hilary R. Franklin

Arch Surg. 1995;130(1):43-47.

Abstract
Objective
To determine the influence of acute regional toxic reactions on the incidence and characteristics of long-term morbidity after regional isolated perfusion with melphalan.

Design
Retrospective study.

Setting
The Amsterdam and Rotterdam perfusion centers, the Netherlands.

Patients
All patients with melanoma who were treated between 1978 and 1990 and had a minimum follow-up of 1 year after perfusion (n=367).

Intervention
Fifty-four patients (15%) had perfusion of the upper limb, 313 (85%) had perfusion of the lower limb, and 164 patients (45%) underwent regional lymph node dissection at the time of perfusion.

Main Outcome Measure
Incidence and characteristics of morbidity 1 year after perfusion and the influence of acute regional toxic reactions on long-term morbidity.

Results
One hundred sixty patients (44%) showed some degree of objective or subjective morbidity; most (104 [28%]) had lymphedema. Other long-term morbidity consisted of muscle atrophy or fibrosis (42 [11%]), limb malfunction (55 [15%]), neuropathy (13 [4%]), pain (28 [8%]), and recurrent infection (11 [3%]). Miscellaneous complications were seen in 14 patients (4%). Seventy-one patients (19%) had more than one complication. Acute regional toxic reactions had a statistically significant effect on the incidence of long-term morbidity (P<.01). Moderate to severe acute regional toxic reactions were strongly linked to the occurrence of muscle atrophy or fibrosis (P<.001) and limb malfunction (P<.001). Regional lymph node dissection was statistically significantly related to lymphedema (P=.05).

Conclusion
Improvement of the perfusion technique should be pursued in an effort to reduce acute regional toxic reactions, and thereby long-term morbidity, without compromising the therapeutic effect.

(Arch Surg. 1995;130:43-47)

Author Affiliations
From the Departments of Surgery, the Netherlands Cancer Institute (Antoni van Leeuwenhoek Huis), Amsterdam (Drs Vrouenraets, Klaase, and Kroon and Ms Franklin), and the Dr Daniel den Hoed Cancer Center, Rotterdam, the Netherlands (Drs van Geel and Eggermont).

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