Induction of systemic serum procalcitonin and cardiocirculatory reactions after isolated limb perfusion with recombinant human tumor necrosis factor-α and melphalan

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Abstract
Isolated, hyperthermic limb perfusion (ILP) with recombinant human tumor necrosis factor-α (rhTNF-α) and melphalan is a highly effective treatment for locoregional metastases of malignant melanoma and for advanced soft tissue sarcoma of the limb. The major systemic side effects are characterized by the induction of a systemic inflammatory response syndrome (SIRS). Procalcitonin (PCT), a serum marker of bacterial sepsis, was investigated with respect to its role in SIRS after ILP. University surgical oncology division with an integrated eight-bed intensive care unit. Thirty-seven patients were treated by ILP with rhTNF-α and melphalan (n = 26) or with cytostatics alone (n = 11) for soft tissue sarcoma or malignant melanoma. The course of serum PCT, interleukin (IL)-6, and IL-8 was analyzed intra- and postoperatively. Hemodynamic variables including heart rate, mean arterial pressure, cardiac index, pulmonary arterial pressure, pulmonary capillary occlusion pressure, and pulmonary and systemic vascular resistance were recorded in parallel. PCT was significantly elevated over baseline after ILP with a maximum between 8 hrs (peak level 16.0 ± 18.8 (SD) ng/mL) and 36 hrs (13.8 ± 15.7 ng/mL) (p Conclusions: Serum procalcitonin is induced as part of the SIRS after ILP with rhTNF-α/melphalan. It may be induced directly by rhTNF-α or other cytokines, because serum peaks of IL-6 and IL-8 precede the peak of PCT. Because there is no correlation between serum levels of PCT and hemodynamic variables, this marker cannot be applied to assess the severity of SIRS reaction after ILP.

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