TY - JOUR
T1 - Technique and results of hyperthermic (41°C) isolated lung perfusion with high-doses of cisplatin for the treatment of surgically relapsing or unresectable lung sarcoma metastasis
AU - Schröder, Carsten
AU - Fisher, Stefan
AU - Pieck, Anne Christin
AU - Müller, Axel
AU - Jaehde, Ulrich
AU - Kirchner, Hartmut
AU - Haverich, Axel
AU - Macchiarini, Paolo
PY - 2002
Y1 - 2002
N2 - Objective: A technique of hyperthermic isolated lung perfusion (ILP) chemotherapy was developed. Methods: Since April 1999, four patients with unilateral (n=2) or bilateral (n=2) sarcoma metastasis confined to a lobe (n=2) or entire lung (n=2) entered into a pilot study of hyperthermic (41°C) ILP with high doses of cisplatin (70 mg/m2). Eligibility included drug resistant metastasis and at least four previous surgical metastasectomies. The ILP of the lung segments was carried out following metastectomy, for 20-40 min at a rate of 0.3-0.5 l/min, a mean perfusion pressure lower than the own mean pulmonary artery pressure, and an inflow temperature of 41°C or higher. Before and following ILP, the isolated lung segments were flushed with normothermic saline (1 l). Flow was continuously maintained by a centrifugal pump. Results: All patients successfully completed 31.7±9 min perfusion time at 41.4±0.3°C, and this time-point corresponded to the maximal platinum lung-uptake (93.8 ng/mg tissue). The total vascular isolation was confirmed by continuously low systemic cisplatin plasma levels. There was no systemic drug-related toxicity but all patients experienced transient pulmonary toxicity as non-cardiogenic edema of the treated lung segments. With a median follow-up of 12 months, three patients are alive and disease-free and one died from cerebral metastasis without autopsy evidence of local recurrence 13 months following ILP. Conclusion: Hyperthermic perfusion chemotherapy can be done safely and effectively. It represents a new treatment modality and deserves further investigations for patients with advanced, drug resistant or surgically refractory, lung sarcoma metastasis. However, further studies are needed to limit the ILP-induced pulmonary toxicity.
AB - Objective: A technique of hyperthermic isolated lung perfusion (ILP) chemotherapy was developed. Methods: Since April 1999, four patients with unilateral (n=2) or bilateral (n=2) sarcoma metastasis confined to a lobe (n=2) or entire lung (n=2) entered into a pilot study of hyperthermic (41°C) ILP with high doses of cisplatin (70 mg/m2). Eligibility included drug resistant metastasis and at least four previous surgical metastasectomies. The ILP of the lung segments was carried out following metastectomy, for 20-40 min at a rate of 0.3-0.5 l/min, a mean perfusion pressure lower than the own mean pulmonary artery pressure, and an inflow temperature of 41°C or higher. Before and following ILP, the isolated lung segments were flushed with normothermic saline (1 l). Flow was continuously maintained by a centrifugal pump. Results: All patients successfully completed 31.7±9 min perfusion time at 41.4±0.3°C, and this time-point corresponded to the maximal platinum lung-uptake (93.8 ng/mg tissue). The total vascular isolation was confirmed by continuously low systemic cisplatin plasma levels. There was no systemic drug-related toxicity but all patients experienced transient pulmonary toxicity as non-cardiogenic edema of the treated lung segments. With a median follow-up of 12 months, three patients are alive and disease-free and one died from cerebral metastasis without autopsy evidence of local recurrence 13 months following ILP. Conclusion: Hyperthermic perfusion chemotherapy can be done safely and effectively. It represents a new treatment modality and deserves further investigations for patients with advanced, drug resistant or surgically refractory, lung sarcoma metastasis. However, further studies are needed to limit the ILP-induced pulmonary toxicity.
KW - Cisplatin
KW - Hyperthermic isolated lung perfusion
KW - Lung sarcoma metastasis
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U2 - 10.1016/S1010-7940(02)00216-6
DO - 10.1016/S1010-7940(02)00216-6
M3 - Article
C2 - 12103371
AN - SCOPUS:0036301991
SN - 1010-7940
VL - 22
SP - 41
EP - 46
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 1
ER -