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

Carsten Schröder, Stefan Fisher, Anne Christin Pieck, Axel Müller, Ulrich Jaehde, Hartmut Kirchner, Axel Haverich, Paolo Macchiarini

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)41-46
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume22
Issue number1
DOIs
StatePublished - Jul 18 2002

Keywords

  • Cisplatin
  • Hyperthermic isolated lung perfusion
  • Lung sarcoma metastasis

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of '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'. Together they form a unique fingerprint.

  • Cite this