Title
Phase II multicenter clinical trial of pulmonary metastasectomy and isolated lung perfusion with melphalan in patients with resectable lung metastasesPhase II multicenter clinical trial of pulmonary metastasectomy and isolated lung perfusion with melphalan in patients with resectable lung metastases
Author
Faculty/Department
Faculty of Medicine and Health Sciences
Research group
Antwerp Surgical Training, Anatomy and Research Centre (ASTARC)
Molecular Imaging, Pathology, Radiotherapy & Oncology (MIPRO)
Publication type
article
Publication
Hagerstown, Md :Lippincott Williams & Wilkins,
Subject
Human medicine
Source (journal)
Journal of thoracic oncology / International Association for the Study of Lung Cancer [Aurora, Colo.] - Hagerstown, Md, 2006, currens
Volume/pages
9(2014):10, p. 1547-1553
ISSN
1556-0864
ISI
000344368000021
Carrier
E
Target language
English (eng)
Full text (Publishers DOI)
Affiliation
University of Antwerp
Abstract
Introduction: The 5-year overall survival rate of patients undergoing complete surgical resection of pulmonary metastases (PM) from colorectal cancer (CRC) and sarcoma remains low (20-50%). Local recurrence rate is high (48-66%). Isolated lung perfusion (ILuP) allows the delivery of high-dose locoregional chemotherapy with minimal systemic leakage to improve local control. Methods: From 2006 to 2011, 50 patients, 28 male, median age 57 years (15-76), with PM from CRC (n = 30) or sarcoma (n = 20) were included in a phase II clinical trial conducted in four cardiothoracic surgical centers. In total, 62 ILuP procedures were performed, 12 bilaterally, with 45 mg of melphalan at 37 degrees C, followed by resection of all palpable PM. Survival was calculated according to the Kaplan-Meier method. Results: Operative mortality was 0%, and 90-day morbidity was mainly respiratory (grade 3: 42%, grade 4: 2%). After a median follow-up of 24 months (3-63 mo), 18 patients died, two without recurrence. Thirty patients had recurrent disease. Median time to local pulmonary progression was not reached. The 3-year overall survival and disease-free survival were 57% +/- 9% and 36% +/- 8%, respectively. Lung function data showed a decrease in forced expiratory volume in 1 second and diffusing capacity of the alveolocapillary membrane of 21.6% and 25.8% after 1 month, and 10.4% and 11.3% after 12 months, compared with preoperative values. Conclusion: Compared with historical series of PM resection without ILuP, favorable results are obtained in terms of local control without long-term adverse effects. These data support the further investigation of ILuP as additional treatment in patients with resectable PM from CRC or sarcoma.
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