Willem A den Hengst1, Jeroen M H Hendriks, Bram Balduyck, Inez Rodrigus, Jan B Vermorken, Filip Lardon, Michel I M Versteegh, Jerry Braun, Hans Gelderblom, Franz M N H Schramel, Wim-Jan Van Boven, Bart P Van Putte, Özcan Birim, Alexander P W M Maat, Paul E Y Van Schil. 1. *Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium; †Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium; ‡Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium; §Center for Oncological Research, University of Antwerp, Wilrijk, Belgium; ‖Department of Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands; ¶Department of Clinical Oncology, Leiden University Medical Center, Leiden, the Netherlands; #Department of Pulmonary Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands; **Department of Thoracic Surgery, Amsterdam Medical Center, Amsterdam, the Netherlands; ††Department of Thoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands; and ‡‡Department of Thoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
Abstract
INTRODUCTION: The 5-year overall survival rate of patients undergoing complete surgical resection of pulmonary metastases (PM) from colorectal cancer (CRC) and sarcoma remains low (20-50%). Local recurrence rate is high (48-66%). Isolated lung perfusion (ILuP) allows the delivery of high-dose locoregional chemotherapy with minimal systemic leakage to improve local control. METHODS: From 2006 to 2011, 50 patients, 28 male, median age 57 years (15-76), with PM from CRC (n = 30) or sarcoma (n = 20) were included in a phase II clinical trial conducted in four cardiothoracic surgical centers. In total, 62 ILuP procedures were performed, 12 bilaterally, with 45 mg of melphalan at 37°C, followed by resection of all palpable PM. Survival was calculated according to the Kaplan-Meier method. RESULTS: Operative mortality was 0%, and 90-day morbidity was mainly respiratory (grade 3: 42%, grade 4: 2%). After a median follow-up of 24 months (3-63 mo), 18 patients died, two without recurrence. Thirty patients had recurrent disease. Median time to local pulmonary progression was not reached. The 3-year overall survival and disease-free survival were 57% ± 9% and 36% ± 8%, respectively. Lung function data showed a decrease in forced expiratory volume in 1 second and diffusing capacity of the alveolocapillary membrane of 21.6% and 25.8% after 1 month, and 10.4% and 11.3% after 12 months, compared with preoperative values. CONCLUSION: Compared with historical series of PM resection without ILuP, favorable results are obtained in terms of local control without long-term adverse effects. These data support the further investigation of ILuP as additional treatment in patients with resectable PM from CRC or sarcoma.
INTRODUCTION: The 5-year overall survival rate of patients undergoing complete surgical resection of pulmonary metastases (PM) from colorectal cancer (CRC) and sarcoma remains low (20-50%). Local recurrence rate is high (48-66%). Isolated lung perfusion (ILuP) allows the delivery of high-dose locoregional chemotherapy with minimal systemic leakage to improve local control. METHODS: From 2006 to 2011, 50 patients, 28 male, median age 57 years (15-76), with PM from CRC (n = 30) or sarcoma (n = 20) were included in a phase II clinical trial conducted in four cardiothoracic surgical centers. In total, 62 ILuP procedures were performed, 12 bilaterally, with 45 mg of melphalan at 37°C, followed by resection of all palpable PM. Survival was calculated according to the Kaplan-Meier method. RESULTS: Operative mortality was 0%, and 90-day morbidity was mainly respiratory (grade 3: 42%, grade 4: 2%). After a median follow-up of 24 months (3-63 mo), 18 patients died, two without recurrence. Thirty patients had recurrent disease. Median time to local pulmonary progression was not reached. The 3-year overall survival and disease-free survival were 57% ± 9% and 36% ± 8%, respectively. Lung function data showed a decrease in forced expiratory volume in 1 second and diffusing capacity of the alveolocapillary membrane of 21.6% and 25.8% after 1 month, and 10.4% and 11.3% after 12 months, compared with preoperative values. CONCLUSION: Compared with historical series of PM resection without ILuP, favorable results are obtained in terms of local control without long-term adverse effects. These data support the further investigation of ILuP as additional treatment in patients with resectable PM from CRC or sarcoma.
Authors: Nathan Haywood; Matthew R Byler; Aimee Zhang; Mark E Roeser; Irving L Kron; Victor E Laubach Journal: Int J Mol Sci Date: 2020-09-17 Impact factor: 5.923