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Isolated limb perfusion (ILP) is a well-established surgical procedure for the administration of high dose chemotherapy to a limb for the treatment of advanced extremity malignancy. Although the technique of ILP was first described over 60 years ago, ILP is utilised in relatively few specialist centres, co-located with tertiary or quaternary cancer centres. The combination of high dose cytotoxic chemotherapy and the cytokine tumour necrosis factor alpha (TNFα), mandates leakage monitoring to prevent potentially serious systemic toxicity. Since the procedure is performed at relatively few specialist centres, an ILP working group was formed with the aim of producing technical consensus guidelines for the procedure to streamline practice and to provide guidance for new centres commencing the technique. Between October 2021 and October 2023 a series of face to face online and hybrid meetings were held in which a modified Delphi process was used to develop a unified consensus document. After each meeting the document was modified and recirculated and then rediscussed at subsequent meeting until a greater than 90% consensus was achieved in all recommendations. The completed consensus document comprised 23 topics in which greater than 90% consensus was achieved, with 83% of recommendations having 100% consensus across all members of the working group. The consensus recommendations covered all areas of the surgical procedure including pre-operative assessment, drug dosing and administration, perfusion parameters, hyperthermia, leakage monitoring and theatre logistics, practical surgical strategies and also post-operative care, response evaluation and staff training. We present the first joint expert-based consensus statement with respect to the technical aspects of ILP that can serve as a reference point for both existing and new centres in providing ILP. [ABSTRACT FROM AUTHOR]

One of the most common issues caused by antineoplastic agents is chemotherapy-induced peripheral neuropathy (CIPN). In patients, CIPN is a sensory neuropathy accompanied by various motor and autonomic changes. With a high prevalence of cancer patients, CIPN is becoming a major problem for both cancer patients and for their health care providers. Nonetheless, there are lacking effective interventions preventing CIPN and treating the CIPN symptoms. A number of studies have demonstrated the cellular and molecular signaling pathways leading to CIPN using experimental models and the beneficial effects of some interventions on the CIPN symptoms related to those potential mechanisms. This review will summarize results obtained from recent human and animal studies, which include the abnormalities in mechanical and temperature sensory responses following chemotherapy such as representative bortezomib, oxaliplatin and paclitaxel. The underlying mechanisms of CIPN at cellular and molecular levels will be also discussed for additional in-depth studies needed to be better explored. Overall, this paper reviews the basic picture of CIPN and the signaling mechanisms of the most common antineoplastic agents in the peripheral and central nerve systems. A better understanding of the risk factors and fundamental mechanisms of CIPN is needed to develop effective preventive and therapeutic strategies. [ABSTRACT FROM AUTHOR]

• A novel Fuzzy P + D µ controller is proposed for controlling the chemotherapy drug delivery system. • The optimal values of the control parameters are obtained with PSO, one of the most effective and common algorithms. • The robustness tests of the controller are also done by changing the intra-patient parameters and using different treatment plans. • The superiority of the study is evident from both the simulation results and the comparison with previous related studies. This paper aims to develop a robust, effective, and optimal controller for an automatic intravenous drug delivery system for the chemotherapy treatment of cancer patients. For this purpose, a novel hybrid control method, namely the Fuzzy P + D µ controller, is designed by combining fractional calculus and fuzzy logic controller (FLC). Particle swarm optimization (PSO) algorithm is employed to tune the controller parameters optimally. To evaluate the performance of the proposed controller, a cancer patient model that considers cumulative drug toxicity, one of the most common side effects of chemotherapy, is utilized. Limits on toxicity and drug concentration for patient safety are incorporated into the controller design and optimization process. The graphical and numerical simulation results show that almost no cancerous cells are left at the end of the treatment period. The effectiveness of the controller is proven by the performance index (PI) obtained. Our optimal hybrid Fuzzy P + D µ outclasses other control techniques in previous related studies with the best PI of 44.426 and the minimum final number of cancerous cells (FNCCs) of 5.084E-08. Moreover, in robustness tests perturbing intra-patient parameters and using different treatment protocols, the cumulative drug toxicity level is kept within safe limits, and almost no cancerous cells remain. [ABSTRACT FROM AUTHOR]