Stop-flow in mediastinum and thorax for resistant lymphoma.
OBJECTIVE
Management of patients with heavily pretreated malignant lymphoma failing frontline treatment and salvage high-dose chemotherapy and autologous peripheral stem cell rescue, is problematic. A pilot study was conducted to evaluate isolated thoracic perfusion of drugs by means of stopflow technique.


METHODS
Six patients were enrolled in the study; diagnoses included 4 advanced Hodgkin's disease, 1 primary mediastinal B-cell lymphoma, and 1 anaplastic large cell lymphoma. Patients were aged 18-37 years; 4 presented with bulky mediastinum. They had never achieved a complete response since all had progressed from front-line treatment, and 3 had even failed salvage high-dose chemotherapy with autologous peripheral stem cell rescue. Cisplatin (100 mg/m2) and melphalan (35 mg/m2) were used. Carmustine (100 mg/m2) were added to these 2 drugs and cytarabine (2000 mg/m2) in patients not previously treated by carmustine, etoposide, cytarabine, and melphalan. Epidoxorubicin (70 mg/m2) was added in patients who previously received a suboptimal dosage of antracycline. Drugs were delivered monthly via aortic perfusion performed by means of Aigner's stop-flow technique.


RESULTS
Overall 13 cycles of perfusional chemotherapy were administered with a median number of 2 cycles. During the procedures there were no technical, hemodynamic, or vascular complications, and no deaths occurred during surgery. After 1 month, 6 (100%) objective responses after isolated thoracic perfusion were recorded, 3 (50%) of which were complete. Tolerance to therapy was excellent. Hematological toxicity was mild and transfusional support was needed only in one course. At the last follow-up, 2 patients are alive (1 complete response and 1 very good partial response, maintained).


CONCLUSIONS
This new therapeutical approach seems very active in recurrent/refractory malignant lymphoma and may play an important role in this setting.
Guadagni
S
S
Department of Surgery, University of L'Aquila, Italy. guadagni@rdn.it
Russo
F
F
Abate
G
G
Pozone
T
T
Capannolo
B
B
Marsili
L
L
D'Alessandro
V
V
Amicucci
G
G
Aigner
K R
KR
Stefano
G
G
Filippo
R
R
Giuseppe
A
A
Tullio
P
P
Benita
C
C
Luca
M
M
Valfredo
D
D
Gianfranco
A
A
Roland
A K
AK
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000295:instrumentation*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D016393:Lymphoma, B-Cell / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D016879:Salvage Therapy; D014057:Tomography, X-Ray Computed
D003561:Cytarabine; D015251:Epirubicin; D002945:Cisplatin; D008558:Melphalan; D002330:Carmustine