{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T05:05:25Z","timestamp":1779512725820,"version":"3.53.1"},"reference-count":33,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Isolated Perfusion Chemotherapy (IPC) with balloon occlusion creates transient ischemic tissue compartments while patients remain exposed to significant perioperative heat loss. Active warming during these phases is commonly avoided due to theoretical concerns regarding impaired heat distribution and potential local heat accumulation in ischemic tissue. This study investigated the thermal safety of forced-air warming during IPC under these conditions. Methods: In this prospective observational study, 31 patients undergoing IPC were monitored during balloon-induced vascular occlusion. Convective warming was applied using a forced-air system set to 43 \u00b0C. Core temperature was measured rectally, and local temperatures were continuously recorded at gluteal, lumbar, and interscapular sites. Temperature trajectories and maximum values during occlusion were analysed descriptively. Results: Local temperature increases during ischemia were limited, with a maximum increase of 2.3 \u00b0C at the lumbar site. Absolute temperatures remained well below the predefined safety threshold of 39.5 \u00b0C at all skin measurement sites (maximum observed 37.7 \u00b0C). Core temperature remained stable throughout the occlusion phase. No evidence of local heat accumulation, threshold exceedance, or thermal skin reactions was observed. Conclusions: Under conditions of controlled application, close temperature monitoring, and short ischemic intervals, forced-air warming during IPC did not result in local overheating or clinically relevant thermal exposure. These findings challenge the prevailing precautionary approach of avoiding active warming during vascular isolation and provide prospective clinical evidence supporting a reassessment of temperature management strategies toward actively maintained normothermia in isolated perfusion chemotherapy.<\/jats:p>","DOI":"10.3390\/cancers18101640","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T13:11:31Z","timestamp":1779196291000},"page":"1640","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Thermal Safety of Forced-Air Warming During Balloon Occlusion in Isolated Perfusion Chemotherapy: A Prospective Feasibility Study Using Multisite Temperature Monitoring"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5477-094X","authenticated-orcid":false,"given":"Hansjoerg","family":"Aust","sequence":"first","affiliation":[{"name":"Medias Klinikum Burghausen, Department of Anaesthesiology, 84489 Burghausen, Germany"},{"name":"University Hospital Giessen and Marburg (UKGM), Clinic of Anaesthesiology and Intensive Care Medicine, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5324-981X","authenticated-orcid":false,"given":"Peter","family":"Kranke","sequence":"additional","affiliation":[{"name":"University Hospital W\u00fcrzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, 97080 W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Torossian","sequence":"additional","affiliation":[{"name":"University Hospital Giessen and Marburg (UKGM), Clinic of Anaesthesiology and Intensive Care Medicine, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1751-7079","authenticated-orcid":false,"given":"Kornelia","family":"Aigner","sequence":"additional","affiliation":[{"name":"Medias Klinikum Burghausen, Department of Tumour Biology, 84489 Burghausen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"ref_1","first-page":"158","article-title":"Selected Perfusion of Isolated Viscera with Chemotherapeutic Agents Using an Extracorporeal Circuit","volume":"8","author":"Ryan","year":"1957","journal-title":"Surg. Forum."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1097\/00000658-195810000-00009","article-title":"Chemotherapy of cancer: Regional perfusion utilizing an extracorporeal circuit","volume":"148","author":"Creech","year":"1958","journal-title":"Ann. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1007\/BF01655820","article-title":"Rationale and indications for perfusion in liver tumors: Current data","volume":"11","author":"Schwemmte","year":"1987","journal-title":"World J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/S1055-3207(18)30393-4","article-title":"Isolated liver perfusion for liver metastases: Pharmacokinetic advantage?","volume":"5","author":"Ravikumar","year":"1996","journal-title":"Surg. Oncol. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1684\/bdc.2009.0803","article-title":"La perfusion pelvienne sous circulation extracorporelle dans les tumeurs pelviennes localement \u00e9volu\u00e9es [Pelvic perfusion for locally advanced tumors]","volume":"96","author":"Bonvalot","year":"2009","journal-title":"Bull. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1016\/S0022-5223(96)70013-2","article-title":"Isolated lung perfusion with melphalan for the treatment of metastatic pulmonary sarcoma","volume":"112","author":"Nawata","year":"1996","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s13304-018-00613-0","article-title":"Isolated thoracic perfusion in lung metastases from breast cancer: A retrospective observational study","volume":"71","author":"Guadagni","year":"2019","journal-title":"Updates Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"129","DOI":"10.3892\/mco.2021.2291","article-title":"Hypoxic isolated abdominal perfusion breaks through chemoresistance in recurrent FIGO stage IIIC and IV ovarian cancer","volume":"14","author":"Aigner","year":"2021","journal-title":"Mol. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Aigner, K.R., Aigner, K., Hendrikx, M.J.H., Bekrentchir, A., and Aust, H. (2025). Isolated hypoxic pelvic perfusion combined with electroporation is a valid alternative to traditional therapies for anal squamous cell carcinoma: A case study. Front. Oncol., 15.","DOI":"10.3389\/fonc.2025.1644317"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2855","DOI":"10.1007\/s00432-019-03019-6","article-title":"Intra-arterial infusion chemotherapy versus isolated upper abdominal perfusion for advanced pancreatic cancer: A retrospective cohort study on 454 patients","volume":"145","author":"Aigner","year":"2019","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.clbc.2017.07.012","article-title":"Scalp hypothermia for preventing alopecia during chemotherapy. A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"18","author":"Rugo","year":"2018","journal-title":"Clin. Breast Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1002\/(SICI)1097-0142(19960901)78:5<1125::AID-CNCR25>3.0.CO;2-3","article-title":"Regional perfusion with hemofiltration (chemofiltration) for the treatment of patients with regionally advanced cancer","volume":"78","author":"Gutman","year":"1996","journal-title":"Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1056\/NEJM199605093341901","article-title":"Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization","volume":"334","author":"Kurz","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1730","DOI":"10.1056\/NEJM199706123362407","article-title":"Mild perioperative hypothermia","volume":"336","author":"Sessler","year":"1997","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1097\/ALN.0b013e31817f6d76","article-title":"Temperature monitoring and perioperative thermoregulation","volume":"109","author":"Sessler","year":"2008","journal-title":"Anesthesiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2655","DOI":"10.1016\/S0140-6736(15)00981-2","article-title":"Perioperative thermoregulation and heat balance","volume":"387","author":"Sessler","year":"2016","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"103059","DOI":"10.1016\/j.amsu.2021.103059","article-title":"Prevention and management of perioperative hypothermia in adult elective surgical patients: A systematic review","volume":"72","author":"Simegn","year":"2021","journal-title":"Ann. Med. Surg."},{"key":"ref_18","first-page":"CD009016","article-title":"Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults","volume":"4","author":"Madrid","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_19","first-page":"166","article-title":"Preventing inadvertent perioperative hypothermia","volume":"112","author":"Torossian","year":"2015","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1046\/j.1365-2044.2001.01982.x","article-title":"The arterial tourniquet: Pathophysiological consequences and anaesthetic implications","volume":"56","author":"Kam","year":"2001","journal-title":"Anaesthesia"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1038\/nm.2507","article-title":"Ischemia and reperfusion\u2014From mechanism to translation","volume":"17","author":"Eltzschig","year":"2011","journal-title":"Nat. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.wem.2013.10.005","article-title":"Comparison of heat donation through the head or torso on mild hypothermia rewarming","volume":"25","author":"Sran","year":"2014","journal-title":"Wilderness Environ. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Hymczak, H., Go\u0142\u0105b, A., Mendrala, K., Plicner, D., Darocha, T., Podsiad\u0142o, P., Hudziak, D., Goco\u0142, R., and Kosi\u0144ski, S. (2021). Core temperature measurement\u2014Principles of correct measurement, problems, and complications. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182010606"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"320","DOI":"10.3109\/02656736.2010.534527","article-title":"Thresholds for thermal damage to normal tissues: An update","volume":"27","author":"Yarmolenko","year":"2011","journal-title":"Int. J. Hyperth."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.jmbbm.2007.09.001","article-title":"Skin biothermomechanics for medical treatments","volume":"1","author":"Xu","year":"2008","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/S1470-2045(02)00818-5","article-title":"Hyperthermia in combined treatment of cancer","volume":"3","author":"Wust","year":"2002","journal-title":"Lancet Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1152\/jappl.1948.1.2.93","article-title":"Analysis of tissue and arterial blood temperatures in the resting human forearm","volume":"1","author":"Pennes","year":"1948","journal-title":"J. Appl. Physiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1109\/10.284920","article-title":"Recent developments in modeling heat transfer in blood perfused tissues","volume":"41","author":"Arkin","year":"1994","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"401","DOI":"10.3109\/08941939809032217","article-title":"A porcine model for investigation of hyperthermic isolated liver perfusion","volume":"11","author":"Lang","year":"1998","journal-title":"J. Investig. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"R33","DOI":"10.1088\/0967-3334\/33\/3\/R33","article-title":"Infrared thermal imaging in medicine","volume":"33","author":"Ring","year":"2012","journal-title":"Physiol. Meas."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Rauch, S., Miller, C., Br\u00e4uer, A., Wallner, B., Bock, M., and Paal, P. (2021). Perioperative hypothermia\u2014A narrative review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18168749"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Wallner, B., Schenk, B., Paal, P., Falk, M., Strapazzon, G., Martini, W.Z., Brugger, H., and Fries, D. (2022). Hypothermia induced impairment of platelets: Assessment with Multiplate vs. ROTEM\u2014An in vitro study. Front. Physiol., 13.","DOI":"10.3389\/fphys.2022.852182"},{"key":"ref_33","unstructured":"3M (2021). Bair HuggerTM Temperature Management Unit Model 775 Operator\u2019s Manual, 3M Patient Warming. Warning: Do not apply heat to ischemic limbs. Thermal injury may occur."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/10\/1640\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T04:14:40Z","timestamp":1779509680000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/10\/1640"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":33,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["cancers18101640"],"URL":"https:\/\/doi.org\/10.3390\/cancers18101640","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]}}}