Paul A J Beckers1, Michel I M Versteegh2, Thomas J Van Brakel2, Jerry Braun2, Bart Van Putte3, Alexander P W M Maat4, Wim Vergauwen5, Inez Rodrigus5, Willem Den Hengst6, Filip Lardon7, Ernst De Bruijn8, Gunther Guetens7, Gert De Boeck7, Jan F Gielis6, Patrick Lauwers9, Laurens Denissen9, Jeroen M H Hendriks10, Paul E Van Schil10. 1. Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Wilrijk, Belgium; Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium. Electronic address: paul.beckers2@uza.be. 2. Department of Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. 3. Department of Thoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands. 4. Department of Thoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. 5. Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium. 6. Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Wilrijk, Belgium. 7. Center for Oncological Research, University of Antwerp, Wilrijk, Belgium. 8. Lab of Experimental Oncology, Department of General Medical Oncology, Katholieke Universiteit Leuven, Leuven, Belgium. 9. Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium. 10. Antwerp Surgical Training, Anatomy and Research Centre, University of Antwerp, Wilrijk, Belgium; Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium.
Abstract
BACKGROUND: Up to 66% of patients show local pulmonary disease progression after pulmonary metastasectomy. Regional treatment with isolated lung perfusion (ILuP) may improve local control with minimal systemic adverse effects. The aims of this study were to evaluate local and distant control after ILuP, determine the effect on overall survival compared with historical controls, and confirm the safety and feasibility of ILuP. METHODS: A total of 107 patients with resectable pulmonary metastases of colorectal carcinoma, osteosarcoma, and soft-tissue sarcoma were included in a prospective phase II study of pulmonary metastasectomy combined with ILuP with 45 mg melphalan at 37°C. Local and distant control, overall survival, lung function, and 90-day mortality and morbidity were monitored. RESULTS: We report 0% mortality, low morbidity, and no long-term pulmonary toxicity. For colorectal carcinoma, median time to local pulmonary progression, median time to progression, and median survival time were 31, 14, and 78 months, respectively. Median time to local progression was not reached for sarcoma, whereas median time to progression and median survival time were 13 and 39 months, respectively. The 5-year disease-free rate and pulmonary progression-free rate were 26% and 44% for colorectal carcinoma and 29% and 63% for sarcoma, respectively. CONCLUSIONS: ILuP with melphalan combined with metastasectomy is feasible and safe. Compared with historical controls, favorable results were obtained in this phase II study for local control. Further evaluation of locoregional lung perfusion techniques with other chemotherapeutic drugs is warranted.
BACKGROUND: Up to 66% of patients show local pulmonary disease progression after pulmonary metastasectomy. Regional treatment with isolated lung perfusion (ILuP) may improve local control with minimal systemic adverse effects. The aims of this study were to evaluate local and distant control after ILuP, determine the effect on overall survival compared with historical controls, and confirm the safety and feasibility of ILuP. METHODS: A total of 107 patients with resectable pulmonary metastases of colorectal carcinoma, osteosarcoma, and soft-tissue sarcoma were included in a prospective phase II study of pulmonary metastasectomy combined with ILuP with 45 mg melphalan at 37°C. Local and distant control, overall survival, lung function, and 90-day mortality and morbidity were monitored. RESULTS: We report 0% mortality, low morbidity, and no long-term pulmonary toxicity. For colorectal carcinoma, median time to local pulmonary progression, median time to progression, and median survival time were 31, 14, and 78 months, respectively. Median time to local progression was not reached for sarcoma, whereas median time to progression and median survival time were 13 and 39 months, respectively. The 5-year disease-free rate and pulmonary progression-free rate were 26% and 44% for colorectal carcinoma and 29% and 63% for sarcoma, respectively. CONCLUSIONS: ILuP with melphalan combined with metastasectomy is feasible and safe. Compared with historical controls, favorable results were obtained in this phase II study for local control. Further evaluation of locoregional lung perfusion techniques with other chemotherapeutic drugs is warranted.
Authors: Matthew R Byler; Nathan S Haywood; Dustin T Money; Aimee Zhang; Jared P Beller; Eric J Charles; William Z Chancellor; Huy Q Ta; Mark H Stoler; J Hunter Mehaffey; Victor E Laubach; Irving L Kron; Mark E Roeser Journal: Semin Thorac Cardiovasc Surg Date: 2021-03-11
Authors: Konstantin Byrgazov; Claes Anderson; Benjamin Salzer; Eva Bozsaky; Rolf Larsson; Joachim Gullbo; Manfred Lehner; Fredrik Lehmann; Ana Slipicevic; Leo Kager; Mårten Fryknäs; Sabine Taschner-Mandl Journal: Ther Adv Med Oncol Date: 2020-07-29 Impact factor: 5.485
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