P1.08-074 Effect of Intrapleural Perfusion Hyperthermic Chemotherapy in Non-Small Cell Lung Cancer with Pleural Seeding

Abstract

Pleural seeding is generally associated with poor prognosis in advanced non-small cell lung cancer (NSCLC). Although palliative chemotherapy is the mainstay modality for these patients, intrapleural perfusion hyperthermic chemotherapy (IPHC) may be a good alternative. The aim of this study was to evaluate the efficacy of IPHC and predictive factors for longer survival in NSCLC with pleural seeding. From 2003 to 2014, 51 patients who underwent IPHC for NSCLC with pleural seeding at the first operation in 36 or after postoperative recurrence in 16 patients were enrolled. IPHC was performed with cisplatin (dose:150mg/m2) for 90 minutes. For patients with pleural seeding at first operation, parenchymal resection was performed and mediastinal LN was evaluated. We included some procedures other than pre-IPHC pleural biopsy, pre-IPHC lavage cytology, post-IPHC lavage cytology, and post-IPHC pleural biopsy. Subjects were divided into two groups: group I is shorter survivor of less than 36 months and group II is longer survivor of more than 36 months of overall survival duration. There were 22 male patients and the mean age was 59.6 years. There were 7 patients in pathologic stage T1, 28 in T2, 13 in T3, and 3 in T4. With respect to N stage, 18 patients in N0, 9 in N1, 17 in N2, and 8 in Nx. Major post-IPHC complication was acute renal insufficiency (n=4). All patients, except 3, received systemic chemotherapy after IPHC. Pleural seeding aggravation was seen in 28 patients, and the development of pleural effusion was observed in 5 patients after IPHC. EGFR mutation was examined in 38 patients after 2007; of which, 20 patients showed to have EGFR mutation. Targeted agents were used in 32 out of 51 patients. The mean overall survival was 36.4 months (5.9-98.0); 28 patients died during the follow-up period. The 2-year and 5-year survival rates were 75.7% and 39.8%, respectively. The prognostic factors for patients with overall survival of more than 36 months, seen in 19 patients, were old age, negative post-IPHC pleural biopsy, and presence of EGFR mutation. IPHC appears to be a safe procedure for advanced lung cancer patients with pleural seeding, and IPHC may provide better survival to only a highly selective group of patients. Old age, negative post-IPHC pleural biopsy, and presence of EGFR mutation are the predictive factors for longer survivor.