Abstract
Hyperthermic intrapleural chemotherapy for malignant pleural disease aims to increase the exposure of malignant cells at the pleural surface to chemotherapeutic agents. Evidence is presented that indeed intrapleural perfusion can result in local exposure for cisplatin and doxorubicin of 60 to 100 times the systemic exposure. Combining chemotherapeutic perfusion of the pleural cavity with mild hyperthermia of 40°–42°C can probably further increase effective tumor cell kill. Effective penetration of the drugs is limited, however. This type of therapy can therefore only work in cases of microscopic residual disease, after complete surgical resection of all malignant pleural disease. A review is presented of studies using this approach in malignant pleural mesothelioma and in pleural involvement in non-small cell lung cancer. In neither disease is there any solid evidence to prove effectivness of hyperthermic pleural chemotherapy. Only in patients with pleural metastases of malignant tymoma has this approach resulted in some unexpected long-term survivors.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Heffner JE, Nietert PJ, Barbieri C. Pleural fluid pH as a predictor of survival in patients with malignant pleural effusions. Chest 2000;117:79–86.
Boutin C, Dumortier P, Rey F, et al. Black spots concentrate oncogenic asbestos fibers in the parietal pleura. Thoracosopic and mineralogic study. Am J Respir Crit Care Med 1996;153:444–449.
Rodrigues-Panadero F, Borderas Naranjo F, Lopez Meijas J. Pleural metastatic tumours and effusions. Frequency and pathogenic mechanisms in a post-mortem series. Eur Respir J 1989;2:366–399.
vanRuth S, Tellingen O van, Korse CM, et al. Pharmacokinetics of doxorubicin and cisplatin used in intra-operative hyperthermic chemotherapy after cytoreductive surgery for malignant pleural mesothelioma and pleural thymoma. Anticancer Drugs 2003; 14:57–65.
Verwaal V, vanRuth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 2003;21:3737–3743.
Ruth S van, Verwaal VJ, Hart AAM, et al. Heat penetration in locally applied hyperthermia in the abdomen during intra-operative intraperitoneal chemotherapy. Anticancer Res 2003;23:1501–1508.
Yonemura Y, de Aretetxabala X, Fujimura T, et al. Intraoperative chemohyperthermic perfusion as an adjunct to gastric cancer: final results of a randomized controlled study. Hepatogastroenterology 2001;48:1776–1782.
Butchart EG, Ashcroft T, Barnsley WC, et al. Pleuropneumonectomy in the management of diffuse malignant mesthelioma of the pleura. Experience with 29 patients. Thorax 1976;31:15–24.
Sugarbaker DJ, Strauss GM, Lynch TJ, et al. Node status has prognostic significance in the multimodality therpy of diffuse malignant mesothelioma. J Clin Oncol 1993;11:1172–1178.
Rusch VW. A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group. Chest 1995;108:1122–1128.
Rusch VW, Piantadosi S, Holmes EC. The role of extra pleural pneumonectomy in malignant pleural mesothelioma. A Lung Cancer Study Group Trial. J Thorac Cardiovasc Surg 1991;102:1–9.
Lee DJ, Perez S, Wang HJ, et al. Intrapleural chemotherapy for patients with incompletely resected malignant mesothelioma: the UCLA experience. J Surg Oncol 1995;60:262–267.
Rusch VW, Saltz L, Venkatraman E, et al. A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma. J Clin Oncol 1994;12:1156–1163.
Colleoni M, Sartori F, Calabro F, et al. Surgery followed by intracavitary plus systemic chemotherapy in malignant pleural mesothelioma. Tumori 1996; 82: 53–56.
Sauter ER, Langer C, Coia IR, et al. Optimal management of malignant mesothelioma after subtotal pleurectomy: revisiting the role of intrapleural chemotherapy and post-operative radiation. J Surg Oncol 1995;60:100–105.
Rice TW, Adelstein DJ, Kirby TJ, et al. Aggressive multimodality therapy for malignant pleural mesothelioma. Ann Thorac Surg 1994;58:24–29.
vanRuth S, Baas P, Haas RLM et al, Cytoreductive surgery combined with intra-operative hyperthermic intrathoracic chemotherapy for stage I malignant pleural mesothelioma. Ann Surg Oncol 2003;10:176–182.
Shigemura N, Akashi A, Nakagiri Tet al, Pleural perfusion thermo-chemotherapy under VATS: a new less invasive modality for advanced lung cancer with pleural spread. Ann Thorac Surg 2004;77: 1016–1021.
Matsuzaki Y, Edagawa M, Shimizu T, et al. Intrapleural hyperthermic perfusion with chemotherapy increases apoptosis in malignant pleuritis. Ann Thorac Surg 2004;78:1769–1772.
Ichinose Y, Tsichiya R, Koike T, et al. A prematurely terminated phase III trial of intrapleural hypotonic cisplatin treatment in patients with resected non small cell lung cancer with positive pleural lavage cytology: the incidence of carcinomatous pleuritis after surgical intervention. J Thorac Cardiovasc Surg 2002;123:695–699.
Yellin A, Simansky DA, Paley M, et al. Hyperthermic pleural perfusion with cisplatin: early experience. Cancer 2001;92:2197–2203.
Refaely Y, Simansky DA, Paley M et al, Resection and perfusion thermochemotherapy: a new approach for the treatment of thymic malignancies with pleural spread. Ann Thorac Surg 2001;72: 366–370.
Sugarbaker DJ, Garcia JP, Richards WG, et al. Extrapleural pneumonectomy in the multimodality therapy of malignant pleural mesothelioma. Results in 120 consecutive patients. Ann Surg 1996;224:288–294.
Janne PA, Baldini EH. Patterns of failure following surgical resection for malignant pleural mesothelioma. Thorac Surg Clin 2004;14:567–573.
Morales M, Exposito MC. Intrapleural mitoxantrone for palliative treatment of malignant pleural effusions. Support Care Cancer 1995;3:147–149.
Aasebo U, Norum J, Sager G, et al. Intrapleurally installed mitoxantrone in metastatic pleural effusions: a phase II study. J Chemother 1997;9:106–111.
Groth G, Gatzemeier U, Haussingen K, et al. Intrapleural palliative treatment of malignant pleural effusions with mitoxantrone versus placebo (pleural tube alone). Ann Oncol 1991;2:213–215.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Humana Press Inc., Totowa, NJ
About this chapter
Cite this chapter
Zoetmulder, F.A.N., van Ruth, S. (2007). Hyperthermic Intrapleural Chemotherapy in Pleural Malignancy. In: Schlag, P.M., Stein, U., Eggermont, A.M.M. (eds) Regional Cancer Therapy. Cancer Drug Discovery and Development. Humana Press. https://doi.org/10.1007/978-1-59745-225-0_24
Download citation
DOI: https://doi.org/10.1007/978-1-59745-225-0_24
Publisher Name: Humana Press
Print ISBN: 978-1-58829-672-6
Online ISBN: 978-1-59745-225-0
eBook Packages: MedicineMedicine (R0)