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Danuzzo F, Sibilia MC, Vaquer S, Cara A, Cassina EM, Libretti L, Pirondini E, Raveglia F, Tuoro A, Petrella F. The Role of Hyperthermic Intrathoracic Chemotherapy (HITHOC) in Thoracic Tumors. Cancers (Basel) 2024; 16:2513. [PMID: 39061153 PMCID: PMC11274823 DOI: 10.3390/cancers16142513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/27/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Pleural mesothelioma (PM) is a rare but aggressive thoracic tumor with a poor prognosis. Multimodal treatment-including induction chemotherapy, aggressive surgical resection, radiotherapy and immunotherapy in selected cases-currently represents the best therapeutic option. Single-center studies advocate hyperthermic intrathoracic chemotherapy (HITHOC) during surgical resection as an additional therapeutic option, although its impact on post-operative morbidity and survival has not yet been evaluated on a larger scale. HITHOC can be applied not only in the case of mesothelioma, but also in the case of thymoma with pleural involvement or-in very selected cases-in patients with secondary pleural metastases. Despite favorable outcomes and reduced clinical risks, there is no uniform approach to HITHOC, and a wide variety of indications and technical applications are still reported. Based on available data, HITHOC seems to offer a clear benefit in regard to overall survival of all mesothelioma patients; however, multicenter randomized controlled trials are required to validate and standardize this approach. The aim of this review is to focus on the present role of HITHOC in thoracic tumors with pleural involvement as well as on future challenges, particularly in the light of possible combined therapy of thoracic tumors still presenting poor prognoses.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Francesco Petrella
- Department of Thoracic Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (F.D.); (M.C.S.); (S.V.); (A.C.); (E.M.C.); (L.L.); (E.P.); (F.R.); (A.T.)
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Miller DL, Parks CS, Ange B, Bonta IR, Rich PT. Hyperthermic intrathoracic extracorporeal chemotherapy for secondary malignant pleural disease. J Surg Oncol 2023; 128:604-611. [PMID: 37409778 DOI: 10.1002/jso.27389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES Pleural metastasis has extremely poor prognosis. Resection of pleural implants with infusion of intrathoracic hyperthermic chemotherapy may offer a survival advantage in selected patients. We evaluated the safety and efficacy of hyperthermic intrathoracic extracorporeal chemotherapy (HITEC) in patients who underwent pleurectomy/decortication (P/D) for secondary malignant pleural disease (SPD). METHODS A total of 101 patients were evaluated over 72 months, with 35 patients electing to proceed with P/D and 60 minutes of HITEC with cisplatin at 42°C. Inclusion criteria were adults 18-79 years with unilateral pleural dissemination. Exclusion criteria were patients without control of primary site, extrathoracic metastatic disease, significant comorbidities, and a history of adverse reaction to cisplatin. RESULTS Median age was 56 years (36-73); 60% were women. SPD was thymoma in 13, breast cancer in 9, lung cancer in 6, colon cancer in 2, renal cell in 2, and esophageal, anal, and thymic cancers in one each. There was no operative mortality. Postoperative complications occurred in 18 patients (51%). No patient developed renal failure. Median follow-up was 24 months (4-60). The overall survival rate was 61%; 17 patients (49%) developed recurrent disease at a median of 12 months (6-36). There were no recurrences after 36 months Eleven patients (31%) died of metastatic disease at a median of 17 months (7-25). CONCLUSIONS Surgical cytoreduction of SPD followed by HITEC with cisplatin was well tolerated. No patient developed cisplatin-related toxicities. Long-term follow-up is warranted to determine survival advantage and refinement of inclusion criteria.
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Chappuy B, Drevet G, Clermidy H, Rosamel P, Duruisseaux M, Couraud S, Grima R, Soldea V, Chalabreysse L, Tronc F, Girard N, Maury JM. Subtotal Pleurectomy with Intrathoracic Chemo Hyperthermia (HITHOC) for IVa Thymomas: De Novo Versus Recurrent Pleural Disease. Cancers (Basel) 2022; 14:cancers14205035. [PMID: 36291819 PMCID: PMC9599523 DOI: 10.3390/cancers14205035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Stage IVa thymomas are rare entities in thoracic oncology without a standard of care. Evidence-based guidelines for the management of located pleural carcinomatosis are lacking. Surgery when feasible has an excellent prognostic factor. However, the technical choice is vast, from extra pleural pneumonectomy with high rates of morbidity and/or mortality to debulking with high rates of relapse. We investigated parietal subtotal pleurectomy combined with HITHOC in highly selected patients. The goal was to determine overall survival (OS) and the disease-free interval (DFI). Our findings suggest a real impact of this surgical procedure in distant relapse (DR) or de novo tumors (DNT). In this orphan disease, prospective and randomized trials are needed to clarify the place of HITHOC in the multimodal modern care of these patients. Abstract Introduction: Stage IVa thymoma is a rare disease without a standard of care. Subtotal pleurectomy and HITHOC introduced in highly selected patients may provide interesting oncologic results. The purpose of this study was to distinguish de novo stage IVa tumors (DNT) from distant relapse (DR) with respect to post-operative and long-term outcomes to provide the procedure efficacy. Methods: From July 1997–December 2021, 40 patients with IVa pleural involvement were retrospectively analyzed. The surgical procedure was subtotal pleurectomy and HITHOC (cisplatin 50 mg/m2, mitomycin 25 mg/m2, 42 °C, 90 min). The post-operative outcome, disease-free interval (DFI) and overall survival (OS) were analyzed. Results: Mean age was 52 ± 12 years. B2 and B3 thymomas were preponderant (27; 67.5%). The median number of pleural nodes were nine (4–81) vs. five (1–36); p = 0.004 * in DNT and DR, respectively. Hospital mortality rate was 2.5%. There were four specific HITHOC complications (10%). DFI were 49 and 85 months (p = 0.02 *), OS were 94 and 118 months (NS), in DNT and DR, respectively. Conclusions: Subtotal pleurectomy with HITHOC in IVa offers satisfying results in highly selected patients, for both DNT and DR. Due to the disease rarity, multicentric studies are needed to define HITHOC as a standard of care.
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Affiliation(s)
- Benjamin Chappuy
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - Gabrielle Drevet
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - Hugo Clermidy
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - Pascal Rosamel
- Department of Anesthesiology and Critical Care Medicine, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - Mickael Duruisseaux
- Department of Thoracic Oncology, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
- Claude Bernard University Lyon 1 (UCBL1), 69677 Lyon, France
| | - Sebastien Couraud
- Claude Bernard University Lyon 1 (UCBL1), 69677 Lyon, France
- Department of Thoracic Oncology, University Hospital Lyon-Sud, GH-Sud, 69677 Lyon, France
| | - Renaud Grima
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - Valentin Soldea
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - Lara Chalabreysse
- Claude Bernard University Lyon 1 (UCBL1), 69677 Lyon, France
- Department of Pathology, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - François Tronc
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
| | - Nicolas Girard
- Department of Thoracic Oncology, Institut Curie, 75005 Paris, France
- RYTHMIC Network, Réseau Tumeurs Thymiques et Cancer, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805 Villejuif, France
| | - Jean-Michel Maury
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, University Hospital Louis Pradel, GH-Est, 69677 Lyon, France
- Claude Bernard University Lyon 1 (UCBL1), 69677 Lyon, France
- RYTHMIC Network, Réseau Tumeurs Thymiques et Cancer, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805 Villejuif, France
- Correspondence: ; Tel.: +33-4-7235-7590; Fax: +33-4-7235-7323
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Markowiak T, Ried M, Larisch C, Nowak D, Hofmann HS, Rakete S. Exposure to cisplatin in the operating room during hyperthermic intrathoracic chemotherapy. Int Arch Occup Environ Health 2022; 95:399-407. [PMID: 34191089 PMCID: PMC8795016 DOI: 10.1007/s00420-021-01738-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/15/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE Hyperthermic intrathoracic chemotherapy (HITOC) is an additive, intraoperative treatment for selected malignant pleural tumors. To improve local tumor control, the thoracic cavity is perfused with a cisplatin-containing solution after surgical cytoreduction. Since cisplatin is probably carcinogenic to humans, potential contamination of surfaces and pathways of exposure should be systematically investigated to enable risk assessments for medical staff and thus derive specific recommendations for occupational safety. METHODS Wipe sampling was performed at pre-selected locations during and after ten HITOC procedures, including on the surgeon's gloves, for the quantitation of surface contaminations with cisplatin. After extraction of the samples with hydrochloric acid, platinum was determined as a marker for cisplatin by voltammetry. RESULTS High median concentrations of cytostatic drugs were detected on the surgeons' (1.73 pg Cis-Pt/cm2, IQR: 9.36 pg Cis-Pt/cm2) and perfusionists' (0.69 pg Cis-Pt/cm2, IQR: 1.73 pg Cis-Pt/cm2) gloves. The display of the perfusion device showed partially elevated levels of cisplatin up to 4.92 pg Cis-Pt/cm2 and thus could represent an origin of cross-contamination. In contrast, cisplatin levels on the floor surfaces in the area of the surgeon and the perfusion device or in the endobronchial tube were relatively low. CONCLUSION With a correct use of personal protective equipment and careful handling, intraoperative HITOC appears to be safe to perform with a low risk of occupational exposure to cisplatin.
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Affiliation(s)
- Till Markowiak
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christopher Larisch
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Dennis Nowak
- Germany and Comprehensive Pneumology Center Munich, University Hospital, LMU Munich, Institute and Clinic for Occupational, Social and Environmental Medicine, Munich, Germany
- Comprehensive Pneumology Center Munich, German Center for Lung Research, Munich, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
- Department of Thoracic Surgery, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Stefan Rakete
- Germany and Comprehensive Pneumology Center Munich, University Hospital, LMU Munich, Institute and Clinic for Occupational, Social and Environmental Medicine, Munich, Germany
- Comprehensive Pneumology Center Munich, German Center for Lung Research, Munich, Germany
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Hyperthermic Intrathoracic Chemotherapy (HITOC) after Cytoreductive Surgery for Pleural Malignancies-A Retrospective, Multicentre Study. Cancers (Basel) 2021; 13:cancers13184580. [PMID: 34572806 PMCID: PMC8470046 DOI: 10.3390/cancers13184580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary There continues to be little research in the literature on perioperative outcomes after cytoreductive surgery (CRS) combined with intraoperative hyperthermic chemotherapy-lavage (HITOC) in patients with malignant pleural tumours. The aim of this multicentre study was to assess the results of the current practice in Germany so as to give recommendations to standardize the procedure. CRS with cisplatin-based HITOC can be performed with low major morbidity and a low rate of renal insufficiency, which was associated with the cisplatin dosage of irrigation. Abstract In the context of quality assurance, the objectives were to describe the surgical treatment and postoperative morbidity (particularly renal insufficiency). A retrospective, multicentre study of patients who underwent cytoreductive surgery (CRS) with cisplatin-based HITOC was performed. The study was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation (GZ: RI 2905/3-1)). Patients (n = 350) with malignant pleural mesothelioma (n = 261; 75%) and thymic tumours with pleural spread (n = 58; 17%) or pleural metastases (n = 31; 9%) were analyzed. CRS was accomplished by pleurectomy/decortication (P/D: n = 77; 22%), extended P/D (eP/D: n = 263; 75%) or extrapleural pneumonectomy (EPP: n = 10; 3%). Patients received cisplatin alone (n = 212; 61%) or cisplatin plus doxorubicin (n = 138; 39%). Low-dose cisplatin (≤125 mg/m2 BSA) was given in 67% of patients (n = 234), and high-dose cisplatin (>125 mg/m2 BSA) was given in 33% of patients (n = 116). Postoperative renal insufficiency appeared in 12% of the patients (n = 41), and 1.4% (n = 5) required temporary dialysis. Surgical revision was necessary in 51 patients (15%). In-hospital mortality was 3.7% (n = 13). Patients receiving high-dose cisplatin were 2.7 times more likely to suffer from renal insufficiency than patients receiving low-dose cisplatin (p = 0.006). The risk for postoperative renal failure is dependent on the intrathoracic cisplatin dosage but was within an acceptable range.
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Klotz LV, Gruenewald C, Bulut EL, Eichhorn F, Thomas M, Shah R, Kriegsmann M, Schmidt W, Kofler O, Winter H, Eichhorn ME. Cytoreductive Thoracic Surgery Combined with Hyperthermic Chemoperfusion for Pleural Malignancies: A Single-Center Experience. Respiration 2021; 100:1165-1173. [PMID: 34384085 DOI: 10.1159/000517334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lung-sparing cytoreductive surgery by extended pleurectomy and decortication (EPD) in combination with hyperthermic intrathoracic chemoperfusion (HITOC) forms a promising treatment strategy for malignant pleural mesothelioma and recurrent pleural thymic malignancies. OBJECTIVES The objective of this study was to scrutinize the surgical procedure and perioperative patient management with emphasis on perioperative morbidity and local tumor control. METHODS In 2014, a standardized EPD and HITOC procedure was implemented at the Thoraxklinik Heidelberg. This retrospective analysis included clinical data of consecutive patients with pleural mesothelioma and pleural metastasized malignancies treated by EPD and HITOC. The surgical procedure, perioperative management, lung function data, and progression-free survival (PFS) were analyzed. RESULTS In the time range between April 2, 2014 and July 2018, 76 patients with pleural malignancies have been treated with EPD and HITOC, and were analyzed retrospectively. It included 61 patients with pleural mesothelioma and 15 patients with pleural metastases of thymic malignancies (12), non-small cell lung cancer (1), colorectal carcinoma (1), and sarcoma (1). Perioperative morbidity following EPD and HITOC treatments represented 23.7% of overall malignancies, while 30- and 90-day mortality were 0 and 1.3%, respectively. Median PFS lasted 18.4 months for mesothelioma and 72.2 months for thymic malignancies. CONCLUSION Combining EPD with HITOC can be performed in patients with either pleural mesothelioma or pleural metastases resulting in low perioperative morbidity and mortality as well as remarkable local tumor control.
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Affiliation(s)
- Laura V Klotz
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Division of Molecular Thoracic Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christiane Gruenewald
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Elena L Bulut
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Florian Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Thomas
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Thoracic Oncology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Rajiv Shah
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Thoracic Oncology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Mark Kriegsmann
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Werner Schmidt
- Department of Anaesthesiology and Intensive Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Othmar Kofler
- Department of Anaesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Hauke Winter
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Martin E Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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Migliore M, Combellack T, Williams J, Kornaszewska M, Valtzoglou V, Pirtnieks A. Hyperthermic intrathoracic chemotherapy in thoracic surgical oncology: future challenges of an exciting procedure. Future Oncol 2021; 17:3901-3904. [PMID: 34346242 DOI: 10.2217/fon-2021-0317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Marcello Migliore
- Thoracic Surgery, Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK.,Minimally Invasive Surgery and New Technologies, Polyclinic Rodolico Hospital, Catania, and Department of General Surgery & Medical Specialties, University of Catania, Catania, Italy
| | - Tom Combellack
- Thoracic Surgery, Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
| | - Jennifer Williams
- Thoracic Surgery, Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
| | - Malgorzata Kornaszewska
- Thoracic Surgery, Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
| | - Vasileios Valtzoglou
- Thoracic Surgery, Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
| | - Ainis Pirtnieks
- Thoracic Surgery, Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
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Larisch C, Markowiak T, Loch E, Großer C, Bednarski PJ, Mueller K, Hofmann HS, Ried M. Assessment of concentration and penetration depth of cisplatin in human lung tissue after decortication and hyperthermic exposure. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:953. [PMID: 34350268 PMCID: PMC8263868 DOI: 10.21037/atm-20-6307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/08/2021] [Indexed: 12/13/2022]
Abstract
Background Hyperthermic perfusion of the pleural cavity with cisplatin after pleurectomy/decortication is an additional therapeutic option to reduce local relapse of malignant pleural tumours. Although there are data on the clinical effect, only little is known about the local impact on human lung tissue by cisplatin. The objective of this experimental study is to evaluate both the concentration and the penetration depth of cisplatin in human lung tissue after normothermic and hyperthermic exposure under ex-vivo-in-vitro conditions. Methods This study was approved by the local ethics committee. In total, 46 patients underwent elective lobectomy and wedge resections were taken from the resected lobes. A decortication of the visceral pleura was performed under ex-vivo conditions, and the tissue samples were incubated with cisplatin (c =0.05 mg/mL) at 37, 42 or 45 °C for 60 minutes. Then the mass concentration of platinum was measured with flameless atomic absorption spectroscopy and then converted into cisplatin concentration. In addition, the current data were compared with previous data of our working group (42 °C, without decortication). Results The overall maximum penetration depth was 7.5 mm due to limitations of our methods. The functional maximum penetration depth did not vary with temperature (P=0.243) but by decortication (P<0.001). The cisplatin concentration decreased with increasing penetration depth (P<0.001). An increase of temperature showed no effect on the cisplatin concentration in decorticated tissue samples (P=0.985). However, decortication at 42 °C significantly increased the cisplatin concentration in comparison to not decorticated tissue samples (P=0.005). Conclusions Decortication of the visceral pleura increases the cisplatin concentration in the lung tissue. Therefore, it possibly reduces the likelihood of a local relapse. An increase of temperature did not show any effect.
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Affiliation(s)
- Christopher Larisch
- Department for Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Till Markowiak
- Department for Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Elena Loch
- Department for Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Christian Großer
- Department for Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049 Regensburg, Germany
| | - Patrick J Bednarski
- Institute of Pharmacy, University of Greifswald, Friedrich-Ludwig-Jahnstrasse 17, 17489 Greifswald, Germany
| | - Karolina Mueller
- Center for Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department for Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.,Department for Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049 Regensburg, Germany
| | - Michael Ried
- Department for Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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Markowiak T, Larisch C, Hofmann HS, Ried M. Hyperthermic intrathoracic chemotherapy (HITHOC): narrative review of the current literature, recommendations and future studies. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:955. [PMID: 34350270 PMCID: PMC8263861 DOI: 10.21037/atm-20-5444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/05/2021] [Indexed: 11/10/2022]
Abstract
Although the method of hyperthermic intrathoracic chemotherapy (HITHOC) after cytoreductive surgery is known for more than 20 years now, the interest of the scientific community has been growing especially in recent years with annually increasing numbers of publications. The feasibility and safety of HITHOC has already been demonstrated. The primary objective now is to reach a consent about the optimal implementation and standardization of the procedure. In the international clinical practice of HITHOC the parameters of temperature, duration, type and number of chemotherapeutic agents vary, making a comparison of the short- and long-term results difficult. For about ten years, the combination of surgical cytoreduction and HITHOC has been performed more routinely in several departments of thoracic surgery in Germany, especially in university hospitals. Recently, a group of experts for thoracic surgery of five departments of thoracic surgery elaborated recommendations for the HITHOC procedure in Germany. These recommendations represent a standardized and consistent implementation of HITHOC. Through this, postoperative complications associated to HITHOC should be reduced and a better comparison of the results should be enabled. This article is intended to give a brief overview of the literature, current recommendations in the implementation of HITHOC and also aims to show future perspectives of this procedure.
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Affiliation(s)
- Till Markowiak
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christopher Larisch
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.,Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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Migliore M, Ried M, Molins L, Lucchi M, Ambrogi M, Molnar TF, Hofmann HS. Hyperthermic intrathoracic chemotherapy (HITHOC) should be included in the guidelines for malignant pleural mesothelioma. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:960. [PMID: 34350275 PMCID: PMC8263862 DOI: 10.21037/atm-20-7247] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/17/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Marcello Migliore
- Thoracic Surgery, Department of Cardio-thoracic Surgery, University Hospital of Wales, UK and Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Laureano Molins
- Department of Thoracic Surgery, Catholic University of Barcelona, Barcelona, Spain
| | - Marco Lucchi
- Thoracic Surgery, University of Pisa, Pisa, Italy
| | | | - Tamas F Molnar
- Thoracic Surgery, Department of Operational Medicine, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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Markowiak T, Koller M, Zeman F, Huppertz G, Hofmann HS, Ried M. Protocol of a retrospective, multicentre observational study on hyperthermic intrathoracic chemotherapy in Germany. BMJ Open 2020; 10:e041511. [PMID: 32690754 PMCID: PMC7375498 DOI: 10.1136/bmjopen-2020-041511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Objective of the 'German hyperthermic intrathoracic chemotherapy (HITOC) study' is to evaluate the HITOC as additional treatment after surgical cytoreduction for malignant pleural tumours. Even though HITOC is applied with increasing frequency, there is no standardised therapy protocol concerning the technique of HITOC, the selection as well as dosage of chemotherapeutic agents and perioperative management in order to provide a safe and comparable, standardised treatment regime. METHODS AND ANALYSIS This trial is a retrospective, multicentre observational study, which is funded by the German Research Foundation. Approximately 300 patients will be included. Four departments of thoracic surgery, which are performing the most HITOC procedures in Germany, are contributing to this study: Center for Thoracic Surgery at the University Hospital Regensburg, Thoracic Clinic Heidelberg of the University of Heidelberg, Center for Thoracic Surgery of the Hospital University of Munich and the Department of Thoracic Surgery at the University Hospital Freiburg. All patients who underwent surgical cytoreduction and subsequent HITOC at one of the four centres between starting the HITOC programme in 2008 and December 2019 will be included. Information on the performed HITOC will be obtained, focusing on the technique as well as the applied perfusion solution including the chemotherapeutic agent. Furthermore, parameters of the patient's postoperative recovery will be analysed to determine 30-day morbidity and mortality. ETHICS AND DISSEMINATION The approvals by the local ethics committee of the respective clinic and the three participating clinics have been obtained. The results will be presented in conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER German Clinical Trials Registry (DRKS00015012; Pre-results).
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Affiliation(s)
- Till Markowiak
- Department of Thoracic Surgery, Universitätsklinikum Regensburg, Regensburg, Bayern, Germany
| | - Michael Koller
- Center for Clinical Studies, Universitätsklinikum Regensburg, Regensburg, Bayern, Germany
| | - Florian Zeman
- Center for Clinical Studies, Universitätsklinikum Regensburg, Regensburg, Bayern, Germany
| | - Gunnar Huppertz
- Center for Clinical Studies, Universitätsklinikum Regensburg, Regensburg, Bayern, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, Universitätsklinikum Regensburg, Regensburg, Bayern, Germany
| | - Michael Ried
- Department of Thoracic Surgery, Universitätsklinikum Regensburg, Regensburg, Bayern, Germany
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12
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Migliore M, Halezeroglu S, Mueller MR. Making precision surgical strategies a reality: are we ready for a paradigm shift in thoracic surgical oncology? Future Oncol 2020; 16:1-5. [PMID: 32447984 DOI: 10.2217/fon-2020-0279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of Surgery & Medical Specialties, University of Catania, Italy
| | - Semih Halezeroglu
- Department of Thoracic Surgery, Faculty of Medicine, Acibadem University, Istanbul, Turkey
| | - Michael R Mueller
- Department of Thoracic Surgery, Otto Wagner Hospital, University of Vienna, Austria
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13
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Markowiak T, Kerner N, Neu R, Potzger T, Großer C, Zeman F, Hofmann HS, Ried M. Adequate nephroprotection reduces renal complications after hyperthermic intrathoracic chemotherapy. J Surg Oncol 2019; 120:1220-1226. [PMID: 31602673 DOI: 10.1002/jso.25726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/27/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Hyperthermic intrathoracic chemotherapy (HITOC) is used for the treatment of malignant pleural tumors. Although HITOC proved to be safe, postoperative renal failure due to nephrotoxicity of intrapleural cisplatin remains a concern. METHODS This single-center study was performed retrospectively in patients who underwent pleural tumor resection and HITOC between September 2008 and December 2018. RESULTS A total of 84 patients (female n = 33; 39.3%) with malignant pleural tumors underwent surgical cytoreduction with subsequent HITOC (60 minutes; 42°C). During the study period, we gradually increased the dosage of cisplatin (100-150 mg/m2 BSA n = 36; 175 mg/m2 BSA n = 2) and finally added doxorubicin (cisplatin 175 mg/m2 BSA/doxorubicin 65 mg; n = 46). All patients had perioperative fluid balancing. The last 54 (64.3%) patients also received perioperative cytoprotection. Overall 29 patients (34.5%) experienced renal insufficiency. Despite higher cisplatin concentrations, patients with cytoprotection showed significantly lower postoperative serum creatinine levels after 1 week (P = .006) and at discharge (P = .020). Also, they showed less intermediate and severe renal insufficiencies (5.6% vs 13.3%). CONCLUSIONS Adequate perioperative fluid management and cytoprotection seem to be effective in protecting renal function. This allows the administration of higher intracavitary cisplatin doses without raising the rate of renal insufficiencies.
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Affiliation(s)
- Till Markowiak
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Nadine Kerner
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Reiner Neu
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Tobias Potzger
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christian Großer
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.,Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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14
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Abstract
In regional chemotherapy of the pleural space a differentiation is made between intrapleural hyperthermic perfusion (IHP) and hyperthermic intrathoracic chemotherapy (HITOC). The HITOC in particular is carried out as an additive procedure after surgical cytoreduction of the pleural tumor manifestation. The main indications are for malignant pleural mesothelioma and thymoma with pleural spread (stage IVa), whereas treatment of secondary pleural carcinomatosis is indicated only in selected patients suitable for resection followed by HITOC. Cisplatin is the standard chemotherapeutic agent and a concentration of 150-175 mg/m2 body surface area is recommended. Postoperative, HITOC-related complications (e.g. renal insufficiency) can be minimized by an adapted perioperative management. Safety measures should be accomplished adhered to for the protection of personnel. The aim of HITOC is to achieve a better local tumor control with a corresponding longer recurrence-free and overall survival.
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Affiliation(s)
- H-S Hofmann
- Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeningerstraße 86, 93049, Regensburg, Deutschland.
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland.
| | - M Ried
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
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15
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Markowiak T, Hofmann HS, Ried M. Intraoperative hypertherme intrathorakale Chemotherapie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2019. [DOI: 10.1007/s00398-018-0260-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Migliore M, Halezeroglu S, Lerut A. Surgery for "advanced" lung and esophageal cancer: new horizons or false dawn? Future Oncol 2018; 14:1-4. [PMID: 29664357 DOI: 10.2217/fon-2018-0212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Marcello Migliore
- Thoracic Unit, Department of General Surgery & Medical Specialties, University of Catania, Catania, Italy
| | - Semih Halezeroglu
- Department of Thoracic Surgery, Acıbadem University, School of Medicine, Istanbul, Turkey
| | - Antoon Lerut
- Thoracic Surgery, Catholic University of Leuven, Belgium
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17
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Bertoglio P, Aprile V, Ambrogi MC, Mussi A, Lucchi M. The role of intracavitary therapies in the treatment of malignant pleural mesothelioma. J Thorac Dis 2018; 10:S293-S297. [PMID: 29507798 DOI: 10.21037/jtd.2017.10.165] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgery is one of the steps of multimodality approach for the treatment of MPM. Due to anatomical features, microscopically radical (R0) resection is never possible and a Macroscopic Complete Resection (R1) is considered the target for mesothelioma surgeons. Recently, intracavitary therapies have been described with the aim of extending the loco-regional effect of surgery. Different agents might be administered intrapleurally: chemotherapy drugs are the most widely used, but also photodynamic therapy (PDT) showed to lead to satisfactory long-term outcomes; furthermore, immunotherapies and gene therapies have been also reported. Despite promising results, no high-quality evidences are currently available and controlled randomized trials are required to establish the exact role of intracavitary therapies and to standardize the technique.
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Affiliation(s)
- Pietro Bertoglio
- Division of Thoracic Surgery, Sacro Cuore Don Calabria Research Hospital and Cancer Care Centre, Negrar, Verona, Italy
| | - Vittorio Aprile
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular pathology and Critical Area, University Hospital of Pisa, via Paradisa 2 56100 Pisa (PI), Italy
| | - Marcello Carlo Ambrogi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular pathology and Critical Area, University Hospital of Pisa, via Paradisa 2 56100 Pisa (PI), Italy
| | - Alfredo Mussi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular pathology and Critical Area, University Hospital of Pisa, via Paradisa 2 56100 Pisa (PI), Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular pathology and Critical Area, University Hospital of Pisa, via Paradisa 2 56100 Pisa (PI), Italy
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18
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Ambrogi MC, Bertoglio P, Aprile V, Chella A, Korasidis S, Fontanini G, Fanucchi O, Lucchi M, Mussi A. Diaphragm and lung-preserving surgery with hyperthermic chemotherapy for malignant pleural mesothelioma: A 10-year experience. J Thorac Cardiovasc Surg 2017; 155:1857-1866.e2. [PMID: 29191688 DOI: 10.1016/j.jtcvs.2017.10.070] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 09/24/2017] [Accepted: 10/12/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The best surgical treatment for malignant pleural mesothelioma is still under a debate, but recent evidence points toward a less-invasive approach to reduce morbidity and mortality. We reported our 10-year experience of a limited surgical approach associated with hyperthermic intrathoracic chemotherapy (HITHOC). MATERIAL AND METHODS Between 2005 and 2014, patients with epithelioid or biphasic malignant pleural mesothelioma were treated with lung-diaphragm-pericardium-sparing pleurectomy associated with double-drug HITHOC; at least 3 cycles of adjuvant chemotherapy were then administered. The primary outcome examined was the feasibility of the procedure, whereas secondary outcomes were overall survival and disease-free interval. RESULTS Among 49 patients, 41 were male. Median age was 68 years (35-76 years). Histology was epithelioid in 43 cases. Pathologic stage I, II, III, and IV occurred in 12, 14, 20, and 3 cases, respectively. No intraoperative complications or postoperative mortality occurred, whereas morbidity rate was 46.9%. Median hospital stay was 8 days (5-45 days). Actuarial median overall survival was 22 months and a 1-, 2-, and 5-year survival accounted for 79.6%, 45.7%, and 9.9%, respectively. Disease-free survival after surgery was 62%, 37.5%, and 18.5% at 1, 2, and 5 years, respectively. Risk factors analysis for overall survival confirmed a significant role for early stages, epithelioid histology, and fibrinogen serum levels. CONCLUSIONS Cytoreductive surgery associated with HITHOC and adjuvant chemotherapy appears feasible and safe, with no mortality and low morbidity. Preserving lung and diaphragmatic function might warrant an acceptable long-term outcome.
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Affiliation(s)
- Marcello Carlo Ambrogi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Pietro Bertoglio
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy.
| | - Vittorio Aprile
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Antonio Chella
- Division of Pneumonology, Cardio Vascular and Thoracic Department, University Hospital of Pisa, Pisa, Italy
| | - Stylianos Korasidis
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Gabriella Fontanini
- Division of Pathological Anatomy, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Olivia Fanucchi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Alfredo Mussi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
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Bertoglio P, Ambrogi MC, Chella A, Aprile V, Dini P, Korasidis S, Fanucchi O, Mussi A. Is less also better? A single-institution experience on treatment of early stage Malignant Pleural Mesothelioma. Eur J Surg Oncol 2017; 43:1365-1371. [PMID: 28274663 DOI: 10.1016/j.ejso.2017.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 01/07/2017] [Accepted: 02/12/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES No clear evidence of which surgical procedure should be performed for early stage mesothelioma is available to date. We analyzed our 10-year experience in the treatment of early stage mesothelioma with surgery and Hyperthermic IntraTHOracic Chemotherapy. METHODS We retrospectively analyzed all cases of histologically proven epithelioid or biphasic IMIG stage I and II mesothelioma that we operated between 2005 and 2014. We performed an open pleurectomy and partial decortication of any visible lesion on the visceral pleura in all cases and both diaphragm and pericardium were always spared; Hyperthermic IntraTHOracic Chemotherapy was ran using Cisplatin 80 mg/m2 and Doxorubicin 25 mg/m2 at a target temperature of 42.5 °C for 60 min. RESULTS We operated on 26 patients (23 male and 3 female); epithelioid tumor was diagnosed in 23 cases. Twelve patients were in IMIG stage I and 14 in IMIG stage II; median overall survival for all patients, stage I and II were 35.6, 46 and 23 months respectively and disease free survival was 18, 18 and 16 months respectively. Our results for stage I were better than those reported in literature and were similar for stage II. We observe no 30- and 90- mortality and the rate of severe complication (all CTCAE stage 3) were 30%; the median postoperative stay was 7.5 days. CONCLUSIONS Our lung sparing approach for the treatment of pleural mesothelioma in early stages allows promising long term outcomes with a complete sparing of pulmonary and diaphragmatic function. Larger studies are needed to confirm our good results.
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Affiliation(s)
- P Bertoglio
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy.
| | - M C Ambrogi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy
| | - A Chella
- Division of Pneumology, Cardio Thoracic and Vascular Department, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy
| | - V Aprile
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy
| | - P Dini
- Division of Thoracic Surgery, Cardio Thoracic and Vascular Department, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy
| | - S Korasidis
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy
| | - O Fanucchi
- Division of Thoracic Surgery, Cardio Thoracic and Vascular Department, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy
| | - A Mussi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy
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20
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Löffler MW, Schuster H, Zeck A, Quilitz N, Weinreich J, Tolios A, Haen SP, Horvath P, Löb S, Rammensee HG, Königsrainer I, Königsrainer A, Beckert S. Pharmacodynamics of Oxaliplatin-Derived Platinum Compounds During Hyperthermic Intraperitoneal Chemotherapy (HIPEC): An Emerging Aspect Supporting the Rational Design of Treatment Protocols. Ann Surg Oncol 2017; 24:1650-1657. [PMID: 28160138 DOI: 10.1245/s10434-017-5790-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hyperthermic intraperitoneal chemotherapy (HIPEC) is used to treat peritoneal surface malignancies with application of cytostatic drugs such as oxaliplatin (OX) after cytoreductive surgery. Despite its increased use, evidence for optimal drug dosage, and notably duration of HIPEC, is scarce. METHODS In this study, OX distribution was comprehensively assessed in nine patients during HIPEC (300 mg OX/m2 body surface area in Physioneal solution for 30 min). Oxaliplatin and its derivatives were measured in peritoneal perfusates over time by liquid chromatography coupled with mass spectrometry (LC-MS), and the resulting total platinum concentration in tissue was analyzed by atomic absorption spectrometry. Additionally, a novel impedance-based real-time cytotoxicity assay was used to evaluate the bioactivity of perfusates ex vivo. RESULTS Compared with amounts of OX expected in peritoneal perfusates by calculation, only 10-15% of the parent drug could be detected by LC-MS during HIPEC. Notably, the study additionally detected platinum compounds consistent with OX transformation, accounting for a further fraction of the applied drug. The cytotoxic properties of perfusates remained unchanged during HIPEC, with only a slight but significant attenuation evidenced after 30 min. CONCLUSIONS The bioactivity of peritoneal perfusates ex vivo is a useful parameter for evaluating the actual cytotoxic potential of OX and its derivatives used in HIPEC over time, overcoming important limitations and disadvantages associated with respective drug monitoring only. Ex vivo cytotoxicity assays may be a promising tool to aid guiding future standardization and harmonization of HIPEC protocols based on drug-mediated effects.
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Affiliation(s)
- Markus W Löffler
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany. .,Department of Immunology, Interfaculty Institute for Cell Biology, University of Tübingen, Tübingen, Germany. .,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Partner Site Tübingen, Tübingen, Germany.
| | - Heiko Schuster
- Department of Immunology, Interfaculty Institute for Cell Biology, University of Tübingen, Tübingen, Germany
| | - Anne Zeck
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - Nicolas Quilitz
- Department of Immunology, Interfaculty Institute for Cell Biology, University of Tübingen, Tübingen, Germany
| | - Jürgen Weinreich
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Alexander Tolios
- Department for Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Sebastian P Haen
- Department of Immunology, Interfaculty Institute for Cell Biology, University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Partner Site Tübingen, Tübingen, Germany.,Internal Medicine, Department for Oncology, Hematology, Immunology, Rheumatology and Pulmonology, University of Tübingen, 72076, Tübingen, Germany
| | - Philipp Horvath
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Stefan Löb
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.,Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Hans-Georg Rammensee
- Department of Immunology, Interfaculty Institute for Cell Biology, University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Partner Site Tübingen, Tübingen, Germany
| | - Ingmar Königsrainer
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ) Partner Site Tübingen, Tübingen, Germany
| | - Stefan Beckert
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
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21
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Migliore M. Debulking surgery and hyperthermic intrathoracic chemotherapy (HITHOC) for lung cancer. Chin J Cancer Res 2017; 29:533-534. [PMID: 29353975 DOI: 10.21147/j.issn.1000-9604.2017.06.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Marcello Migliore
- Thoracic Surgery Unit, A.O.U. Policlinico-Vittorio Emanuele, Department of Surgery and Medical Specialities, University of Catania, Catania 95123, Italy
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22
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Zhou H, Wu W, Tang X, Zhou J, Shen Y. Effect of hyperthermic intrathoracic chemotherapy (HITHOC) on the malignant pleural effusion: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e5532. [PMID: 28072694 PMCID: PMC5228654 DOI: 10.1097/md.0000000000005532] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although hyperthermic intraperitoneal chemotherapy (HIPEC) has been widely used to treat malignant ascites or as a preventive strategy for microscopic carcinomatosis following surgical resection of abdominal tumors, application of hyperthermic intrathoracic chemotherapy (HITHOC) in the treatment of malignant pleural effusion is limited. The objective of the current study was to conduct a systematic review and meta-analysis on the application of HITHOC in the palliative treatment of malignant pleural effusion. METHODS After thorough searching of online databases, total 27 articles were included into qualitative systematic review and 5 of them were used to conduct qualitative meta-analysis. RESULTS It was found that most of HITHOC was used in combination of cytoreductive surgery (CRS) including pleurectomy/decortication or after surgical resection of primary tumors, which mainly were lung cancer, thymoma or thymic carcinoma, breast cancer, and ovarian cancer. Patients who received HITHOC had significantly longer median survival length compared to the patients without HITHOC (Hedges g = 0.763, P < 0.001). In addition, HITHOC therapy was favored (Hedges g = 0.848, P < 0.001) in terms of median survival length, tumor-free survival rate, with tumor survival rate or Karnofsky performance status (KPS) scale. CONCLUSION HITHOC is a safe and effective therapy in controlling pleural effusion and increasing patient's survival rate.
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Affiliation(s)
- Hua Zhou
- Department of Respiration, The First Affiliated Hospital, Zhejiang University, Hangzhou
| | - Wei Wu
- Department of Radiology, Jilin Provincial Tumor Hospital, Changchun, China
| | - Xiaoping Tang
- Department of Respiration, The First Affiliated Hospital, Zhejiang University, Hangzhou
| | - Jianying Zhou
- Department of Respiration, The First Affiliated Hospital, Zhejiang University, Hangzhou
| | - Yihong Shen
- Department of Respiration, The First Affiliated Hospital, Zhejiang University, Hangzhou
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23
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Migliore M, Calvo D, Criscione A, Palmucci S, Fuccio Sanzà G, Caltabiano R, Spatola C, Privitera G, Aiello MM, Parra HS, Ciancio N, Di Maria G. Pleurectomy/decortication and hyperthermic intrapleural chemotherapy for malignant pleural mesothelioma: initial experience. Future Oncol 2016; 11:19-22. [PMID: 26638918 DOI: 10.2217/fon.15.286] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cytoreductive surgery and hyperthermic intraoperative intrapleural chemotherapy (HITHOC) are a known option for malignant pleural mesothelioma (MPM). This prospective study was started to prove that pleurectomy/decortication and HITHOC could be successfully performed in a low volume center. Criteria of inclusion were a proven diagnosis of MPM, early-stage disease and good performance status. Six consecutive patients were enrolled. After pleurectomy/decortication, intrapleural cisplatin was administered for 60 min at 42.5 °C. Wedge resections and diaphragmatic reconstruction were added in two and one patient, respectively. Morbidity was 16.6%. Mortality was nil. Hospital stay was 7.8 days. Mean survival was 21.5 months (range: 6-30). This small experience confirms that pleurectomy/decortication and HITHOC are a good therapeutic option in the multimodality treatment of MPM. A randomized controlled trial is necessary.
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Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Damiano Calvo
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Alessandra Criscione
- Section of Thoracic Surgery, Department of General Surgery & Medical Specialities, University of Catania, Policlinico Hospital, Catania, Italy
| | - Stefano Palmucci
- Radiodiagnostic & Radiotherapy Unit, Policlinico Hospital, Catania, Italy
| | | | | | - Corrado Spatola
- Radiodiagnostic & Radiotherapy Unit, Policlinico Hospital, Catania, Italy
| | - Giuseppe Privitera
- Radiodiagnostic & Radiotherapy Unit, Policlinico Hospital, Catania, Italy
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