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Kombinierte Technik der chirurgischen Zytoreduktion und hyperthermen intrathorakalen Chemotherapieperfusion

The combined technique of cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Die effektive Behandlung von primären und sekundären malignen Tumoren der Pleura setzt einen multimodalen Therapieansatz zur Verbesserung der Prognose voraus. Mit einer chirurgisch kompletten makroskopischen Zytoreduktion in Kombination mit einer hyperthermen intrathorakalen Chemotherapieperfusion (HITHOC) scheint seit einigen Jahren eine entscheidende Verbesserung der Tumorkontrolle und somit auch der Prognose erreicht worden zu sein. Nach chirurgischer Zytoreduktion, bestehend aus parietaler und viszeraler Pleurektomie mit Dekortikation, wird durch die intraoperative Anwendung der HITHOC eine homogene Verteilung des Zytostatikums mit deutlich höheren Konzentrationen gegenüber der systemischen Chemotherapie erzielt. Bei ausgewählten Patienten stellt dieses Behandlungsregime eine neue Therapieoption mit deutlich verminderter Morbidität und Mortalität dar und ist eine gute Alternative zu radikaleren Resektionsverfahren, wie der extrapleuralen Pneumonektomie. Patienten mit primären und sekundären Malignomen der Pleura sollten daher auch hinsichtlich dieses Verfahrens interdisziplinär evaluiert werden.

Der vorliegende Beitrag erläutert insbesondere die technischen Aspekte der chirurgischen Zytoreduktion kombiniert mit der hyperthermen Chemotherapieperfusion im Pleuraraum und verschafft einen Überblick über die aktuelle Literatur.

Abstract

The multimodal approach using macroscopic cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion (HITHOC) may improve local tumor control and prognosis of patients with primary and secondary pleural tumors. After complete surgical cytoreduction, consisting of parietal and visceral pleurectomy, the intraoperative HITHOC procedure allows for better local dissemination and a higher concentration of the chemotherapeutics in the pleural cavity in contrast to systemic application. This new combined treatment strategy can result in improved patient survival with acceptable morbidity and mortality in selected patients, having no indication for radical resection (extrapleural pneumonectomy). Patients with primary and secondary tumors of the pleural should be evaluated by an interdisciplinary team, concerning this therapeutic alternative.

In this report, cytoreductive surgery combined with hyperthermic intrathoracic chemotherapy perfusion is discussed, and the current literature is reviewed.

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  1. Abteilung für Thoraxchirurgie, Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Franz-Josef Strauss Allee 11, 93053, Regensburg, Deutschland

    M. Ried, C. Diez, R. Neu & H.-S. Hofmann

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  1. M. Ried
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  2. C. Diez
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  3. R. Neu
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  4. H.-S. Hofmann
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Ried, M., Diez, C., Neu, R. et al. Kombinierte Technik der chirurgischen Zytoreduktion und hyperthermen intrathorakalen Chemotherapieperfusion. Z Herz- Thorax- Gefäßchir 24, 277–284 (2010). https://doi.org/10.1007/s00398-010-0802-1

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  • DOI: https://doi.org/10.1007/s00398-010-0802-1

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