Izolirana ekstremitetna perfuzija Isolated limb perfusion

Povzetek

Izolirana ekstremitetna perfuzija (ILP) je oblika regionalnega zdravljenja napredovalih rakov udov. Prvič je bila opisana v 50. letih prejšnjega stoletja in se je s časom nadgrajevala. Tako so v 80. letih najprej dodali hipertermijo, v 90. letih pa še citokin TNF (tumor necrosis factor). Danes z ILP zdravimo bolnike z lokoregionalno napredovalim melanomom (intranzit zasevki) in sarkomi, pri katerih bi bila za radikalnost potrebna amputacija uda. Pri posegu izoliramo arterijo in veno za spodnji oz. zgornji ud in ju priključimo na napravo za zunajtelesni krvi obtok, s čimer ud izoliramo od sistemskega krvnega obtoka. Ud nato segrejemo na temperaturo okoli 40 o C in z izotopno metodo izključimo komunikacijo med izoliranim obtokom uda in sistemskim obtokom. Če med sistemoma ne uhaja tekočina, apliciramo citostatik. Koncentracija citostatika v izoliranem sistemu je 10- do 20-krat večja, kot je zaradi neželenih učinkov možno pri sistemski aplikaciji. Po posegu ud izperemo, zašijemo arterijo in veno ter ga znova priključimo na sistemski krvni obtok. Pooperativni zapleti so večinoma omejeni na ud in so navadno blagi (eritem in edem). Pri bolnikih z melanomom dosežemo popolni odgovor pri približno 70 % bolnikov, pri bolnikih s sarkomi pa nam omenjeni poseg omogoči ohranitev uda pri 80 % bolnikov, pri katerih bi bila sicer potrebna amputacija.

Abstract (Eng)

Isolated limb perfusion (ILP) is a form of regional treatment of locally advanced limb cancers. It was first described in 1950s and modified with time. In 1980s, hyperthermia was added and in 1990s TNF (tumor necrosis factor). ILP is indicated in the patients with locoregionally advanced melanoma (in transit metastases) and in the patients with limb sarcomas where amputation would be the only radical treatment. During the procedure, the artery and vein for lower/upper limb is isolated and connected to the heart-lung machine. In the first part of the procedure, the isolated limb is warming to about 40o C and leakage measurements with isotope are performed. If there is no leakage, cytotoxic drug is applied in the dosage 10-20 times higher than the maximal dosages during systemic application. At the end of the procedure, the limb is washed out and the vessels repaired. Postoperative complications are usually regional in the form of erythema and edema. ILP is an effective treatment with complete response rates reaching 70% in patients with melanoma and 80% limb sparing in patients with advanced sarcomas.