Abstract
BackgroundThe usual treatments for pleural malignancies are mostly palliative. In contrast, peritoneal malignancies are often treated with a curative intent by cytoreductive surgery and intraperitoneal chemotherapy. As pressure has been shown to increase antitumor efficacy, we applied the concept of high-pressure intracavitary chemotherapy to the pleural space in a swine model.MethodsCisplatin and gemcitabine were selected because of their antineoplasic efficacy in vitro in a wide spectrum of cancer cell lines. The pleural cavity of 21 pigs was filled with saline solution; haemodynamic and respiratory parameters were monitored. The pressure was increased to 15-25 cm H2O. This treatment was associated with pneumonectomy in 6 pigs. Five pigs were treated with chemotherapy under pressure.ResultsThe combination of gemcitabine (100 mg/l) and cisplatin (30 mg/l) was highly cytotoxic in vitro. The maximum tolerated pressure was 20 cm H20, due to haemodynamic failure. Pneumonectomy was not tolerated, either before or after pleural infusion. Five pigs survived intrapleural chemotherapy associating gemcitabine and cisplatin with 20 cm H2O pressure for 60 min.ConclusionsHigh-pressure intrapleural chemotherapy is feasible in pigs. Further experiments will establish the pharmacokinetics and determine whether the benefit already shown in the peritoneum is also obtained in the pleura.
Highlights
The usual treatments for pleural malignancies are mostly palliative
Whereas peritoneal carcinomatosis may be treated by cytoreductive surgery followed by intraperitoneal chemotherapy with curative intent, the treatment of malignant pleural effusion is generally purely palliative [2,3]
At a pressure of about 15 cm H2O (11.5 mmHg), the mediastinal pleura broke in both pigs and the filled right pleural cavity was confirmed by ultrasonography and autopsy
Summary
The usual treatments for pleural malignancies are mostly palliative. Peritoneal malignancies are often treated with a curative intent by cytoreductive surgery and intraperitoneal chemotherapy. Whereas peritoneal carcinomatosis may be treated by cytoreductive surgery followed by intraperitoneal chemotherapy with curative intent, the treatment of malignant pleural effusion is generally purely palliative [2,3]. Chemical or physical pleural abrasion, pleurodesis with sclerosing agents or talc are palliative treatments usually administered with concomitant systemic chemotherapy. Their objective is to alleviate the dyspnea but not to sterilize the pleural tumor [4]. As the pleura has the same histology as the peritoneum, we hypothesized that isolated pleural combination of drugs when used for high-pressure intrapleural chemotherapy
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