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Various toxicities: 11 case reports Eleven women were identified from a retrospective study after they developed various toxicities following treatment with dactinomycin and melphalan [some times to onset not stated]. The women, aged 38–92 years, underwent isolated limb infusion for locally advanced malignant melanoma of the lower limb. In each case, percutaneous catheters were inserted in the popliteal artery and vein, and a tourniquet and compressive bandage were applied. Melphalan 7 mg/L and dactinomycin 70 µg/L (maximum 400µg) were combined with warmed sodium chloride and infused through the arterial line. The doses were proportional to the volume of the limb. The drug infusate was continuously circulated by repeated venous aspiration and reinjection into the arterial catheter. After 25–30 minutes, the infusion was stopped, and normal limb circulation was restored. Nine patients subsequently developed either grade II or III limb toxicity, with three of these women also developing cellulitis requiring antibiotics, and one developing deep vein thrombosis 2 weeks after her second procedure. Another woman developed grade IV limb toxicity on postoperative day 2, with compartment syndrome requiring fasciotomy. One woman had no evidence of limb toxicity; however, she developed systemic toxicity due to placement of the venous catheter proximal to the tourniquet. On postoperative day 8 this woman also developed neutropenic sepsis with a urinary tract infection. Her reaction was thought to be caused by systemic leakage of melphalan. [Patient outcomes not stated]. Chun J-Y, et al. Technique and outcomes of isolated limb infusion for locally advanced malignant melanoma - A radiological perspective. Clinical Radiology 66: 1175-1180, No. 12, Dec 2011. Available from: URL: http://dx.doi.org/10.1016/ 803066525 j.crad.2011.07.049 - United Kingdom

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Reactions 4 Feb 2012 No. 1387