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.
Highlights
In Japan, seventy thousand lung cancer patients have died every year; the number of dead was mostly due to malignancies, 80% of which consisted of non-small cell carcinoma
The intrapleural hyperthermic chemotherapy (IPHC) treatment resulted in no major complications, and fewer adverse events of more than grade 3
The LC group consisted of advanced lung cancers (n = 4), intraoperatively-found dissemination (n = 1), and postoperative recurrences (n = 3)
Summary
In Japan, seventy thousand lung cancer patients have died every year; the number of dead was mostly due to malignancies, 80% of which consisted of non-small cell carcinoma. By the seventh edition of the tumor-node-metastasis (TNM) staging system for lung cancer [1], an advanced lung cancer with pleural dissemination and/or malignant pleural effusion was defined as M1a, which is described as “tumour with pleural nodules or malignant pleural/pericardial effusion”, displayed as stage IV the same as advanced cases with a distant metastasis This type of lung cancer is considered to have no indication for surgery, aggressive therapy should be difficult due to the poor performance status and poor quality of life (QOL), and an effective treatment has not yet been established. 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).
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