Combined surgery of intrapleural perfusion hyperthermic chemotherapy and panpleuropneumonectomy for lung cancer with advanced pleural spread: a pilot study.

For the treatment of lung cancer with advanced pleural spread, aggressive local treatment could offer a chance of cure. This study evaluates the early and midterm results of our Phase I trial for the new modality of two-stage approach combining thoracoscopic intrapleural perfusion hyperthermic chemotherapy (TIPHC) and panpleuropneumonectomy for the disease. Five patients were enrolled in this study. All had proven lung cancer with major malignant pleural effusion or numerous pleural dissemination. The combined regimen was planned first with TIPHC using high doses of cisplatin, followed by a second stage with panpleuropneumonectomy with full-thoracotomy approach as radical surgery. All patients successfully completed this treatment, and there were no serious complications. Panpleuropneumonectomy was performed 14+/-1.2 days after TIPHC, and the mean operation time was 280+/-35 min, the blood loss was 620+/-89 ml. One patient with pathological N2 developed liver metastases 8 months after surgery and died. The other four patients are living and have not experienced any recurrence to date. The mean survival time is 19 months, and the longest is 32 months. Our new treatment modality is feasible and seems to provide a possibility for safe and effective radical local tumor control for patients of lung cancer with advanced carcinomatous pleuritis.