Clinical outcomes of cytoreductive surgery combined with intrapleural perfusion of hyperthermic chemotherapy in advanced lung adenocarcinoma with pleural dissemination

Abstract

Background: This study aimed to investigate the safety and feasibility of intrapleural perfusion hyperthermic chemotherapy (IPHC) followed by cytoreductive surgery as a part of multimodal strategy for the treatment of advanced lung adenocarcinoma. Methods: Medical records of advanced lung cancer patients with pleural dissemination who underwent surgical treatment between 2003 and 2013 were reviewed retrospectively. Enrolled patients were divided into a surgery group comprising patients who underwent surgery only and an IPHC group, which consisted of patients who underwent surgery combined with IPHC. Results: A total of 33 patients were enrolled in this study. Twenty-three patients underwent IPHC after surgical resection, and 10 patients underwent surgical resection only. The complication rate of the IPHC group was estimated to be 34.8% (8 cases), none of which included postoperative mortality. The complication rate of the surgery group was 40.0% (4 cases), which included one postoperative mortality.The 6-month, 1-year, and 3-year overall survival rates for the IPHC group were 95.7%, 91.3% and 38.6%, respectively, while those of the surgery group were 80.0%, 80.0% and 37.5%. The 6-month, 1-year and 3-year progression-free survival rates for the IPHC group were 87.0%, 47.8% and 24.3%, while those of surgery group were 44.4%, 33.3% and 0.0%, respectively. There were significant differences in overall survival rates between two groups (P=0.045); however, progression-free survival was not different between the two groups. Conclusions: IPHC combined with cytoreductive surgery for advanced lung adenocarcinoma associated with pleural seeding could be performed safely and feasible. It would be part of multimodality therapy for certain category of advanced lung adenocarcinoma. However, the long-term benefits for survival is uncertain.More extensive and precisely designed studies are warranted to further evaluate the effectiveness of IPHC.

Management of Malignant Lung Entrapment, the Oncothorax

“…This modality also can be applied in lung cancer with pleural dissemination, as reported by Yi and colleagues. 53 The investigators used a 90-minute perfusion of 150 mg/m 2 of cisplatin with mannitol and thiosulphate protection at 43 to 45°C. There was statistically significant improvement of overall survival at 6 months, 1 year, and 3 years (95.7%, 91.3%, and 38.6% vs 80.0%, 80.0%, and 37.5%) and trend toward improved progression-free survival (87.0%, 47.8%, and 24.3%, vs 44.4%, 33.3%, and 0.0%).…”

Does cytoreduction surgery and hyperthermic intrathoracic chemotherapy prolong survival in patients with N0–N1 nonsmall cell lung cancer and malignant pleural effusion?

“…HU et al [22] performed video-assisted thoracoscopic surgery pleural biopsy and HITHOC in 54 patients with malignant pleural effusion caused by lung carcinoma with a median survival of 21.7 months and a 1-year survival rate of 74.1%. YI et al [23] performed an interesting study on 23 patients with advanced lung adenocarcinoma who underwent debulking surgery alone versus debulking surgery with HITHOC, which was continued for only 30 min (compared with 60 min in our technique). The complication rate was 34.8% versus 40%, while the 3-year survival rate was 24.3% versus 0% ( p=0.045), respectively.…”

Long noncoding RNA OSER1‑AS1 promotes the malignant properties of non‑small cell lung cancer by sponging microRNA‑433‑3p and thereby increasing Smad2 expression

“…The standard care of patients with NSCLC is chemoradiotherapy for stage III and chemotherapy for stage IV. Previous studies have reported that cytoreductive surgery can improve the quality of life of patients with advanced or distant metastasis of lung cancer (25,26); hence, the 29 NSCLC patients diagnosed with stage III-IV admitted in our study received cytoreductive surgery. NSCLC tissues and adjacent normal tissues were obtained after surgical resection and immediately frozen and conserved in liquid nitrogen.…”