Monitoring system for isolated limb perfusion based on a portable gamma camera

Summary

Background: The treatment of malignant melanoma or sarcomas on a limb using extremity perfusion with tumour necrosis factor (TNF-α) and melphalan can result in a high degree of systemic toxicity if there is any leakage from the isolated blood territory of the limb into the systemic vascular territory. Leakage is currently controlled by using radiotracers and heavy external probes in a procedure that requires continuous manual calculations. The aim of this work was to develop a light, easily transportable system to monitor limb perfusion leakage by controlling systemic blood pool radioactivity with a portable gamma camera adapted for intraoperative use as an external probe, and to initiate its application in the treatment of MM patients. Methods: A special collimator was built for maximal sensitivity. Software for acquisition and data processing in real time was developed. After testing the adequacy of the system, it was used to monitor limb perfusion leakage in 16 patients with malignant melanoma to be treated with perfusion of TNF-α and melphalan. Results: The field of view of the detector system was 13.8 cm, which is appropriate for the monitoring, since the area to be controlled was the precordial zone. The sensitivity of the system was 257 cps/MBq. When the percentage of leakage reaches 10% the associated absolute error is ± 1%. After a mean follow-up period of 12 months, no patients have shown any significant or lasting side-effects. Partial or complete remission of lesions was seen in 9 out of 16 patients (56%) after HILP with TNF-α and melphalan. Conclusion: The detector system together with specially developed software provides a suitable automatic continuous monitoring system of any leakage that may occur during limb perfusion. This technique has been successfully implemented in patients for whom perfusion with TNF-α and melphalan has been indicated.

Zusammenfassung

Hintergrund: Bei der Behandlung maligner Melanome oder Sarkome der Gliedmaßen mit Extremitätenperfusion mit Tumor-Nekrose-Faktor- alpha (TNF-α) und Melphalan kann deren Austritt aus dem isolierten Gefäßbett in den systemischen Kreislauf eine ausgeprägte Toxizität verursachen. Zurzeit erfolgt die Leckage-Kontrolle mit Radiotracern und schweren externen Messgeräten in einem Verfahren, das ständige manuelle Berechnungen erfordert. Das Ziel dieser Arbeit war, die Entwicklung eines leichten, einfach zu transportierenden Systems zum Leckage-Monitoring bei Extremitätenperfusion, wobei die Radioaktivität des systemischen Blutpools mit einer transportablen Gamma-Kamera, adaptiert als externes Messgerät für das intraoperative Monitoring, kontrolliert wird. Ziel war auch, die Anwendung dieses Systems bei MM-Patienten einzuführen. Methoden: Für maximale Sensitivität wurde eine spezielle Blende konstruiert. Für die Datenerfassung und -verarbeitung in Echtzeit wurde eine Software entwickelt. Nach einem Eignungstest wurde das System bei 16 MM-Patienten, die eine Extremitätenperfusion mit TNF-α und Melphalan erhalten sollten, zum Leckage-Monitoring eingesetzt. Ergebnisse: Das Beobachtungsfeld des Detektorsystems war mit 13,8 cm angemessen für das Monitoring des präkordialen Kontrollbereichs. Die Sensitivität des Systems betrug 257 cps/MBq. Wenn der Leckageanteil 10% erreicht, liegt der absolute Fehler bei ± 1%. Nach einer mittleren Nachbeobachtungszeit von 12 Monaten zeigte kein Patient signifikante oder bleibende Nebenwirkungen. Partielle oder vollständige Remissionen der Läsionen wurden nach HILP mit TNF-α und Melphalan bei 9 von 16 Patienten (56%) beobachtet. Schlussfolgerung: Das Detektorsystem mit der speziell entwickelten Software, eignet sich zur automatischen, kontinuierlichen überwachung von Leckagen während der Extremitätenperfusion. Es wurde erfolgreich bei Patienten eingesetzt, bei denen die Perfusion mit TNF-α und Melphalan indiziert war.

Keywords

Limb perfusion - tumour necrosis factor alfa - melphalan - radiotracer - gamma camera - leakage monitoring

Schlüsselwörter

Extremitätenperfusion - Tumor-Nekrose-Faktoralpha - Melphalan - Radiotracer - Gamma-Kamera - Leckage-Monitoring

Publication History

Received: 29 October 2008

Accepted: 05 May 2009

Publication Date:
22 January 2018 (online)

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