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Eur J Cardiothorac Surg 2002;22:41-46
© 2002 Elsevier Science NL
a Division of Cardio-thoracic and Vascular Surgery, Hannover Medical School, Hannover, Germany
b Institute of Pharmacy, Clinical Pharmacy, University of Bonn, Bonn, Germany
Received 2 December 2001; received in revised form 7 March 2002; accepted 25 March 2002.
* Corresponding author. Tel.: +49-511-790-6290; fax: +49-511-790-6266
e-mail: pmacchiarini{at}compuserve.com
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.
Key Words: Hyperthermic isolated lung perfusion • Cisplatin • Lung sarcoma metastasis
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