TITLE:
Clinical Outcomes, Safety and Efficacy of Intrapleural Hyperthermic Chemotherapy for Thoracic Malignant Diseases with Pleural Effusion
AUTHORS:
Takanori Ayabe, Masaki Tomita, Eiichi Chosa, Hiroki Mori, Kunihide Nakamura
KEYWORDS:
Intrapleural, Hyperthermic, Chemotherapy, Lung Cancer, Mesothelioma, Thoracic Malignancies
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.7 No.3,
March
18,
2016
ABSTRACT: Background: We have performed the cisplatin-based intrapleural hyperthermic
chemotherapy (IPHC) for advanced lung cancer with pleural effusion and for
malignant pleural mesothelioma (MPM). Retrospectively, the outcomes of the IPHC
were evaluated. Methods: For 14 years from February, 2000 to February, 2014, we
performed 14 cases of IPHC including 8 lung cancers (staged-IV) and 6 MPMs
(staged-III: 5; IV: 1). We divided these cases in two groups; the lung cancer
group (LC group) and MPM group, and assessed the perioperative factors, toxicities,
and effectiveness. Results: The patient age averaged 66.5 ± 11.1 years old (11
males and 3 females). The pathology was 7 pulmonary adenocarcinomas, 1
pulmonary angiosarcoma, and 6 epithelial type MPMs. The regimens of the IPHC
were CDDP (300 mg) plus saline (n = 12), CDDP (100 mg) plus saline (n = 1), and
CDDP (300 mg) plus distilled water (n = 1). The operation and IPHC time was 204
± 70 and 59 ± 19 minutes, respectively. Intraoperative complication was
observed in 2 lung injuries due to exfoliation of the pleural adhesion in the LC
group. Blood loss was 292 ± 365 ml. The postoperative complication, i.e., subcutaneous emphysema, was
observed as grade 2 pulmonary fistula (7.1%, 1/14), which was significantly
observed in the LC group (1/8, 12.5%) compared to the MPM group (0/8, 0%) (p = 0.040).
The hematological toxicity of more than grade 3 was observed in only one case
of anemia (7.1%, 1/14) and in the LC group (25%, 1/8). The grade 3 anemia (25%,
1/8) and grade 2 neutropenia (25%, 1/8) in the LC group were significantly
observed compared to those in the MPM group (0%, 0/6), respectively (p = 0.040).
The postoperative cytology of the malignant cells in the pleural effusion
resulted in the negative (n = 6), positive (n = 7), and not evaluated (n = 1),
and the control rate was calculated to be 46.2% (6/13). There was no
significant difference between the two groups (p = 0.083), that is, 42.9% (3/7)
in the LC group and 50.0% (3/6) in the MPM group. For the postoperative amounts
of the pleural effusion, reduction (n = 10), unchanged (n = 3), and not
evaluated (n = 1), the control rate was calculated to be 76.9% (10/13). There
was a significant difference between the two groups (p = 0.042), that is, 71.4%
(5/7) in the LC group and 83.3% (5/6) in the MPM group. Conclusion: The IPHC
treatment resulted in no major complications, and fewer adverse events of more
than grade 3. The outcome of the IPHC was safety, and a very effective control
of the malignant cells and pleural effusion.