Long-term results of intrathoracic chemohyperthermia (ITCH) for the treatment of pleural malignancies

Abstract

There is no standard treatment for patients with pleural malignancies. The aim of this prospective study was to investigate the toxicity and long-term results of a multimodality treatment consisting of surgery and intrathoracic chemohyperthermia (ITCH) for the treatment of patients with pleural malignancies. From January 1990 to August 2000, 24 patients with mesothelioma (n ¼ 17), fibrosarcoma (n ¼ 3), pleural adenocarcinoma (n ¼ 3) and thymoma (n ¼ 1) were included. The mesothelioma stages were T1 or T2 in 10 cases, and T3 or T4 in seven cases. After cytoreductive surgery, ITCH was carried out for over 60 min, at inflow temperatures less than 451C, either with mitomycin C (n ¼ 7) or cisplatin (n ¼ 5) or both (n ¼ 12). One patient died from major thoracic air leaks after major decortication and pleurectomy. Seven patients had complications, one pleural clotting necessitating reoperation. After a median follow-up of 89 months, the overall 1-year and 5-year survival rates were 74 and 27%, respectively. For T1 and T2 mesothelioma patients, the median survival was 41.3 months, and for T3 and T4 tumours, it was 4.5 months (P ¼ 0.001). The fibrosarcoma patients are alive with no evidence of recurrence at 24, 43 and 54 months. In the conclusion, the combination of surgery with ITCH with mitomycin and/or cisplatin is relatively safe. This procedure may offer unexpected long-term survival in a selected group of patients (T1 and T2 mesothelioma patients and fibrosarcoma patients).

Therapeutic antitumor efficacy of anti-epidermal growth factor receptor antibody, cetuximab, against malignant pleural mesothelioma

“…To date, several local treatments have been reported as successful in combination with other therapeutic modalities, such as surgery. These local treatments include intrathoracic chemotherapy (58), chemohyperthermia (59), and intraoperative photodynamic therapy (IPDT) (60). Our proposed combination therapy using cetuximab with IL-2 is preferable for the local treatment of MPM, because IL-2 causes serious side effects such as vascular leakage syndrome and systemic immuno-suppression if administered systemically (61).…”

Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma

“…Some reports have been made on the use of pre-and post-operative chemotherapy combined with hyperthermia. This approach, however, is not tested in a multi-centre fashion [95][96][97]. All surgical combination therapies that included EPP can only be performed at the cost of additional morbidity (f70%) and a mortality rate in specialised centres that should be ,7% (level of evidence: strong/low-quality evidence).…”

New therapeutic options for mesothelioma

“…Intrapleural local chemotherapy only treats tumor on the external surface of the lung but can be paired with hyperthermia to increase penetration and tumor cell kill. In a series using pleurectomy or PD and intrapleural hyperthermic mitomycin C, Monneuse et al [8] achieved a median survival of 41.3 months in 10 T1/T2 mesothelioma patients and 4.5 months in seven patients with T3/T4 disease. A phase I dose-escalation trial found the maximum tolerated dose of intraoperative cisplatin lavage during EPP to be 250 mg/m 2 [9], and a similar study with patients undergoing PD found the maximum tolerated dose to be 225 mg/m 2 .…”