A phase I study of extrapleural pneumonectomy and intracavitary intraoperative hyperthermic cisplatin with amifostine cytoprotection for malignant pleural mesothelioma
Autor: | Lucian R. Chirieac, Bruce E. Johnson, William G. Richards, Michael T. Jaklitsch, Raphael Bueno, Lambros Zellos, Leah Capalbo, David J. Sugarbaker |
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Jazyk: | angličtina |
Předmět: |
Extrapleural Pneumonectomy
Pulmonary and Respiratory Medicine Male Mesothelioma medicine.medical_specialty Maximum Tolerated Dose Pleural Neoplasms Antineoplastic Agents Radiation-Protective Agents Pleural disease Intraoperative Period Amifostine medicine Humans Stage (cooking) Pneumonectomy Neoplasm Staging Cisplatin business.industry Respiratory disease Hyperthermia Induced Middle Aged medicine.disease Survival Analysis Surgery Cytoprotection Toxicity Feasibility Studies Female business Cardiology and Cardiovascular Medicine medicine.drug |
Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. (2):453-458 |
ISSN: | 0022-5223 |
DOI: | 10.1016/j.jtcvs.2008.07.055 |
Popis: | Objective This study was undertaken to determine maximum tolerated dose and toxicity of intraoperative intracavitary hyperthermic cisplatin perfusion with amifostine after extrapleural pneumonectomy for malignant pleural mesothelioma. Methods Patients with mesothelioma were prospectively enrolled. Those with resectable disease received amifostine and 1-hour hyperthermic cisplatin perfusion of ipsilateral hemithorax and abdomen. Morbidity, recurrence, and survival were recorded. Results Forty-two patients were enrolled; 29 underwent resection (operative mortality 7%, 2/29). Median age was 57 years. Eighteen were in pathologic stage I or II; 11 were in stage III. Median hospitalization was 15 days. Common complications were atrial fibrillation (66%, 19 patients), deep venous thrombosis (31%, 9 patients), and grade 3+ renal toxicity (31%, 9 patients). Feasibility was determined. Renal toxicity was unrelated to cisplatin dose, with no maximum tolerated dose determined. Overall median survival was 17 months (resected 20 months, unresected 10 months). Median survivals were 26 months for patients receiving higher cisplatin doses and 16 months for those receiving lower doses ( P = .35). Survival was significantly longer with negative extrapleural nodes (31 vs 14 months, P = .0115) and early stage (all resected 35 months for stage I–II vs 14 months for stage III, P = .0022, epithelial 39 months for stage I–II vs 15 months for stage III, P = .0072). Conclusion Early stage and negative extrapleural lymph nodes were associated with prolonged survival. Single-dose amifostine did not protect adequately against cisplatin-induced renal toxicity. Additional cytoprotective strategies are needed to allow determination of cisplatin maximum tolerated dose. |
Databáze: | OpenAIRE |
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