Medical Radiology and Radiation Safety. 2019. Vol. 64. No. 4. P. 48–55

DOI: 10.12737/article_5d110f04375033.57581297

B.Ya. Narkevich^1,2, S.V. Shiryaev², I.V. Lagutina^1,2, Yu.V. Buydenok², T.K. Kharatishvili², N.S. Petrochenko²

Leakage Radiometric Control of Chemical Drugs with Regional Perfusion of Surgical Isolated Limbs

1. Association of Medical Physicists of Russia, Moscow, Russia. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ;
2. N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia

B.Ya. Narkevich – President of the AMPR, Leading Researcher, Dr. Sci. Tech., Prof., Academician of International Academy of Engineering;
S.V. Shiryaev – Head of Lab., Dr. Sci. Med., Prof., Member of the European Association of Nuclear Medicine and Molecular Imaging, Member of the American College of Nuclear Medicine and Molecular Imaging, Member of the Society of Nuclear Medicine and Molecular Imaging;
I.V. Lagutina – Medical Physicist;
Yu.V. Buydenok – Perfusiologist, Leading Researcher, Dr. Sci. Med.;
T.K. Kharatishvili – Surgeon, Leading Researcher, Dr. Sci. Med., Prof.;
N.S. Petrochenko – Surgeon, PhD Med.

Abstract

Purpose: Modernization and evaluation of the clinical effectiveness of the technology of continuous radiometric monitoring carried out during high-dose chemotherapy of a surgically isolated limb with tumor foci.

Material and methods: A modernized radiometric control technology for regional limb perfusion is proposed. It is based on in vivo labeling of erythrocytes with ^99mTc eluate followed by continuous monitoring of the activity of labeled erythrocytes as a simulator of a chemotherapy drug over the heart region. Its distinctive features are intravenous injection of a pyrfotech slice after giving inhalation anesthesia to ensure a sufficient level of red blood cell chelation, as well as using ^99mTc activity less than its minimum significant level, which allows working with an open source of ionizing radiation without violating the requirements of radiation safety regulations.

Results: The developed technology was successfully used with 106 regional perfusion of the upper and lower extremities in patients with melanoma or sarcoma of soft tissues. In 4 cases, according to the results of radiometric control, the intervention of the surgical team was required to reduce the chemical preparation leakage that was occurring.

Conclusion: The technology upgraded by us is characterized by ease of implementation, the ability to take timely measures to prevent or reduce the leakage of a chemotherapy drug from an isolated limb according to the results of continuous in vivo radiometric monitoring of ^99mTc-labeled red blood cells over the heart, as well as low radiation load on the patient and staff.

Key words: high-dose chemotherapy, surgically isolated limb, regional perfusion, chemotherapy leaks, radiometric monitoring

REFERENCES

1. Gargon GI, Pkhakadze NR, Senchik KYu, Gelfold VM. Perspective methods for treating patients with soft-tissue sarcomas of the extremities (isolated regional perfusion, local hyperthermia). Practical Oncology. 2004;5(4):276-84. (Russian).
2. Zwavelig JH, Maring JK, Mulder AB, et al. Effects of hyperthermic isolated limb perfusion with recombinant tumor necrosis factor α and melphalan on the human fibrinolytic system. Cancer Res. 1996;56: 3948-53.
3. Goldberg ME, Rosenblum HM, Seltzer JL, Rosato FE. Isolated regional perfusion: anesthetic technique, monitoring and blood replacement. Canad J Anesthesia. 1984. Sep;512-58. DOI: 10.1007 / BF03009542
4. Kroon HM. Treatment of locally advanced limb infusion with citotoxic drugs. J Skin Cancer. 2011;Article ID 106573. 7 pp.
5. Tatyanicheva NV. Evaluation of the effectiveness of the method of isolated regional perfusion in the combined treatment of patients with soft tissue sarcomas and skin melanoma of the extremities. Author. PhD Med. S.-Pb. 2012. 24 p. (Russian).
6. Shiryaev SV, Goncharov MO, Narkevich BYa. Development of radionuclide semiotics of liver hemangiomas using single-photon emission computed tomography with labeled red blood cells in the differential diagnosis of liver tumors. Med Fizika. 2009;3(43): 44-55 (Russian).
7. Basic Sanitary Rules for Radiation Safety OSPORB-99/2010. SP 2.6.1.2612–10. (as amended by change No. 1, approved by the resolution of the Chief State Sanitary Doctor of the Russian Federation of September 16, 2013 No. 43). (Russian).
8. Vidal-Sicart S, Rull R, Barriuso C, Nieweg OE. Monitoring for systemic leakage during limb perfusion for melanoma. In: Radioguided Surgery. Ed. by Herrmann K, Nieweg OE, Povoski SP. Springer. 2016;359-69.
9. Vrouenraets BC, Eggermont .M, Hart AA, et al. Limb perfusion with melphalan and tumor necrosis factor-alpha versus toxicity after melphalan alone. Regional Eur J Surg Oncol. 2001;24(4):390-5.
10. Di Filippo F, Rossi CR, Santinami M, Di Filippo S. Hyperthermic isolation limb perfusion with TNFα in the treatment of in-transit melanoma metastasis. In vivo. 2006;20:739-42.
11. National Radionuclide Diagnosis Manual. Lishmanov YuB, Chernov VI (Ed.) Vol. 2. Tomsk: STT. 2010;73-4. (Russian).
12. Wierts R, Lazarenko SV, de Jong JR, Willemsen AT. Characteristics of the leakage factor during regional hyperthermic isolated limb perfusion. Nucl Med Commun. 2011;32(9):858-62.
13. Paulsen IF, Chakera AH, Schmidt G, Drjøe J, Klyver H, Oturai PS, et al. Radionuclide leakage monitoring during hyperthermic isolated limb perfusion for local melanoma metastasis in an extremity. Clin Physiol Funct Imaging. 2014;6(6). DOI:  10.1111/cpf.12164
14. Fiz F, Villa G, Ferrari E, Pomposelli E, Morbelli S, Alloisio A. Prevention of systemic toxicity in hyperthermic isolated lung perfusion using radioisotopic leakage monitoring. Int J Hypertherm. 2007;1-10. DOI: 10.1080/02656736.2017.1355485
15. Villa G, De Cian F, Pomposelli E, et al. Continuous leakage monitoring with Sn-medronat-^99mTc-labeled RBC and hand-held gamma-probe during hyperthermic limb and lung perfusion. Il Giornale di Chirurgia. 2009;30(5 suppl.): 240-1.
16. Lipanova NN, Narkevich BYa. Evaluation of the patient and staff radiation dose at radiometric monitoring of open sources in diagnostics. Med Fizika. 2011;3(51):81-5. (Russian).
17. Orero A, Vidal-Sicart S, Roé N. Monitoring system for isolated limb perfusion based on a portable gamma camera. Nuklearmedizine. 2009;48(4): 166-72.
18. MedicalView >> Product. 3 sense. https: // www. medicalview.ea /? page_id = 31

For citation: Narkevich BYa, Shiryaev SV, Lagutina IV, Buydenok YuV, Kharatishvili TK, Petrochenko NS. Leakage Radiometric Control of Chemical Drugs with Regional Perfusion of Surgical Isolated Limbs. Medical Radiology and Radiation Safety. 2019;64(4):48–55. (Russian).

DOI: 10.12737/article_5d110f04375033.57581297

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