Clinical Outcomes, Safety and Efficacy of Intrapleural Hyperthermic Chemotherapy for Thoracic Malignant Diseases with Pleural Effusion

Abstract

Background: We have performed the cisplatin-based intrapleural hyperthermic chemotherapy (IPHC) for advanced lung cancer with pleural effusion and for malignant pleural mesothelioma (MPM). Retrospectively, the outcomes of the IPHC were evaluated. Methods: For 14 years from February, 2000 to February, 2014, we performed 14 cases of IPHC including 8 lung cancers (staged-IV) and 6 MPMs (staged-III: 5; IV: 1). We divided these cases in two groups; the lung cancer group (LC group) and MPM group, and assessed the perioperative factors, toxicities, and effectiveness. Results: The patient age averaged 66.5 ± 11.1 years old (11 males and 3 females). The pathology was 7 pulmonary adenocarcinomas, 1 pulmonary angiosarcoma, and 6 epithelial type MPMs. The regimens of the IPHC were CDDP (300 mg) plus saline (n = 12), CDDP (100 mg) plus saline (n = 1), and CDDP (300 mg) plus distilled water (n = 1). The operation and IPHC time was 204 ± 70 and 59 ± 19 minutes, respectively. Intraoperative complication was observed in 2 lung injuries due to exfoliation of the pleural adhesion in the LC group. Blood loss was 292 ± 365 ml. The postoperative complication, i.e. , subcutaneous emphysema, was observed as grade 2 pulmonary fistula (7.1%, 1/14), which was significantly observed in the LC group (1/8, 12.5%) compared to the MPM group (0/8, 0%) (p = 0.040). The hematological toxicity of more than grade 3 was observed in only one case of anemia (7.1%, 1/14) and in the LC group (25%, 1/8). The grade 3 anemia (25%, 1/8) and grade 2 neutropenia (25%, 1/8) in the LC group were significantly observed compared to those in the MPM group (0%, 0/6), respectively (p = 0.040). The postoperative cytology of the malignant cells in the pleural effusion resulted in the negative (n = 6), positive (n = 7), and not evaluated (n = 1), and the control rate was calculated to be 46.2% (6/13). There was no significant difference between the two groups (p = 0.083), that is, 42.9% (3/7) in the LC group and 50.0% (3/6) in the MPM group. For the postoperative amounts of the pleural effusion, reduction (n = 10), unchanged (n = 3), and not evaluated (n = 1), the control rate was calculated to be 76.9% (10/13). There was a significant difference between the two groups (p = 0.042), that is, 71.4% (5/7) in the LC group and 83.3% (5/6) in the MPM group. Conclusion: The IPHC treatment resulted in no major complications, and fewer adverse events of more than grade 3. The outcome of the IPHC was safety, and a very effective control of the malignant cells and pleural effusion.