JTCS Email Content Delivery
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
William G. Richards
Lambros Zellos
Michael T. Jaklitsch
Aneil A. Mujoomdar
Christopher T. Ducko
Raphael Bueno
David J. Sugarbaker
Right arrow Permission Requests
Google Scholar
Right arrow Articles by Tilleman, T. R.
Right arrow Articles by Sugarbaker, D. J.
PubMed
Right arrow Articles by Tilleman, T. R.
Right arrow Articles by Sugarbaker, D. J.
Related Collections
Right arrow Lung - other
Right arrow Pleura

J Thorac Cardiovasc Surg 2009;138:405-411
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Extrapleural pneumonectomy followed by intracavitary intraoperative hyperthermic cisplatin with pharmacologic cytoprotection for treatment of malignant pleural mesothelioma: A phase II prospective study

Tamara R. Tilleman, MD, PhDa, William G. Richards, PhDa, Lambros Zellos, MD, MPHa, Bruce E. Johnson, MDb, Michael T. Jaklitsch, MDa, Jordan Muellera, Beow Yong Yeap, ScDc, Aneil A. Mujoomdar, MDa, Christopher T. Ducko, MDa, Raphael Bueno, MDa, David J. Sugarbaker, MDa,*

a Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
b Dana Farber Cancer Institute, Boston, Mass
c Department of Medicine, Massachusetts General Hospital, Boston, Mass

Received for publication May 15, 2008; revisions received January 9, 2009; accepted for publication February 23, 2009.

* Address for reprints: David J. Sugarbaker, MD, Division of Thoracic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. (Email: dsugarbaker{at}partners.org).

Objective: We sought to prospectively determine the feasibility and safety of hyperthermic intraoperative intracavitary cisplatin perfusion immediately after extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma.

Methods: Patients with malignant pleural mesothelioma who were surgical candidates underwent extrapleural pneumonectomy followed by hyperthermic intraoperative intracavitary cisplatin perfusion, consisting of a 1-hour lavage of the chest and abdomen with cisplatin (42°C) at 225 mg/m2. Pharmacologic cytoprotection consisted of intravenous sodium thiosulfate with or without amifostine. Morbidity and mortality were recorded prospectively.

Results: Ninety-six (79%) of 121 enrolled patients underwent extrapleural pneumonectomy, of whom 92 (76%) received hyperthermic intraoperative intracavitary cisplatin perfusion after extrapleural pneumonectomy. Fifty-three (58%) patients had epithelial tumors, and 39 (42%) had nonepithelial histology. Hospital mortality was 4.3%. Morbidity (grade 3 or 4, 49%) included atrial fibrillation in 22 (23.9%) patients, venous thrombosis in 12 (13%) patients, and laryngeal nerve dysfunction in 10 (11%) patients. Nine patients had renal toxicity, which was attributable to cisplatin in 8 of them. Among the 27 patients who also received amifostine (910 mg/m2), 1 patient had grade 3 renal toxicity attributable to cisplatin. Recurrence of malignant pleural mesothelioma was documented in 47 (51%) patients, with ipsilateral recurrence in 17.4% of patients. The median survival of the 121 enrolled patients was 12.8 months.

Conclusions: Hyperthermic intraoperative intracavitary cisplatin perfusion following extrapleural pneumonectomy can be performed with acceptable morbidity and mortality. The use of amifostine in addition to sodium thiosulfate might reduce cisplatin-associated renal toxicity. Hyperthermic intraoperative intracavitary cisplatin perfusion following extrapleural pneumonectomy might enhance local control in the chest.

Abbreviations and Acronyms BWH = Brigham and Women's Hospital; EPP = extrapleural pneumonectomy; HIOC = hyperthermic intraoperative chemotherapy; IMRT = intensity-modulated radiation therapy; MCR = macroscopic complete resection; MPM = malignant pleural mesothelioma; MTD = maximal tolerated dose; P/D = pleurectomy/decortication; POD = postoperative day






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2009 by The American Association for Thoracic Surgery.