[Surgery and hyperthermic pleural perfusion--a new approach for malignancies with pleural involvement].
BACKGROUND
Malignant neoplasms involving the pleura have a poor prognosis. In some cases the main symptoms and the cause of death are due to local spread, whereas metastases, if at all, develop late. The preferred treatment of these tumors is not clear.


OBJECTIVE
To evaluate whether regional therapy that includes resection, local chemotherapy and hyperthermia is feasible, safe and effective for tumors with pleural spread.


METHODS
Forty-three patients undergoing surgery and hyperthermic pleural perfusion were studied retrospectively. The majority had mesothelioma, or thymic malignancies with pleural spread. Twenty-five patients received previous treatment. The extent of resection was dictated by tumor type and patients condition. Perfusion was performed with a roller pump and heat exchanger plus cisplatinum in a dose of 60-200 mg.


RESULTS
Intrapleural temperature exceeded 40 degrees C in all patients. There were no hemodynamic, or respiratory problems related to perfusion. There was neither intraoperative mortality nor hematologic, renal or systemic toxicity. Three patients died (7% mortality) and 14 had complications. The overall 1, 2, 3, and 5-year survival rates ware 78%, 72%, 50% and 36% respectively. The best survival was for thymoma patients--70% after 3 and 5 years, and the worst for metastatic tumors--31% 3-year survival. Among 39 patients followed-up for more than 1 year (24 alive, 15 dead), 28 (72%) were free of ipsilateral pleuro-pulmonary recurrence.


CONCLUSIONS
Surgery and hyperthermic pleural perfusion is feasible and relatively safe. This method offers a good chance of complete midterm local eradication of neoplasms with pleural spread. A survival benefit over other modalities is suggested in patients with thymoma. Other drugs, alone or in combinations, should be studied.
Yellin
Alon
A
Sheba Medical Center, Tel Hashomer.
Simansky
David
D
Paley
Michael
M
Friedman
Henry
H
Teperberg
Maya
M
Refaely
Yael
Y
D001831:Body Temperature; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D010997:Pleural Neoplasms / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors