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Mesothelioma
Treatment
Articles
and Abstracts
Pleural
space perfusion with cisplatin in the
multimodality treatment of malignant
mesothelioma: a feasibility and
pharmacokinetic study.
J
Thorac Cardiovasc 1999
Apr;117(4):759-65
Ratto
GB, Civalleri D, Esposito M, Spessa E,
Alloisio A, De Cian F, Vannozzi
MO
Istituto
Anatomia Chirugica and Istituto Clinica
Chirurgica, University of Genoa, Istituto
Nazionale per la Ricerca sul Cancro,
Servizio di Farmacologica Tossicologica,
Genoa, Italy.
INTRODUCTION:
Malignant pleural mesothelioma is an ideal
model for testing new locoregional
multimodality approaches because of its
aggressive local behavior.
METHODS:
This study was planned to investigate the
feasibility, safety, and pharmacokinetics
of a multimodality therapy including an
operation, pleural space perfusion (60
minutes) with cisplatin (100 mg/m2),
hyperthermia (41.5 degrees C), and
postoperative radiotherapy (55 Gy to chest
wall incisions). The effects of the extent
of resection and perfusion temperature on
cisplatin pharmacokinetics were evaluated.
Ten patients with epithelial or mixed,
stage I or II, malignant pleural
mesothelioma underwent the following
procedures: group A (3 patients),
pleurectomy/decortication and normothermic
pleural space antineoplastic perfusion;
group B (3 patients),
pleurectomy/decortication and hyperthermic
perfusion; and group C (4 patients),
pleuropneumonectomy and hyperthermic
perfusion. Operations were selectively
applied depending on tumor extent.
Platinum levels were serially measured by
atomic absorption in systemic blood,
perfusate, lung, and endothoracic
fascia.
RESULTS:
The overall procedure was completed in
every case, without any death or toxicity.
No lung damage was demonstrated after
treatment. Major complications included 1
wound infection and 1 diaphragmatic
prosthesis displacement. The mean peak
platimum plasma levels were reached within
45 to 60 minutes after perfusion was
started. Systemic drug concentrations were
reached after pleurectomy/decortication
that after pleuropneumonectomy (P=.006).
The local tissue/perfusate ratio of
platimum concentrations tended to be
higher after hyperthermic perfusion rather
than normothermic perfusion.
CONCLUSION:
This multimodality appraoch is feasible,
pharmacokinetically advantageous, and safe
enough to undergo further clinical
investigations.
PMID:
9689814, UI: 98354239
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