Percutaneous venovenous perfusion-induced systemic hyperthermia for lung cancer: a phase I safety study.

Abstract

Veno-venous perfusion-induced systemic hyperthermia (VV-PISH) homogeneously raises core body temperature potentially improving outcomes from metastatic lung cancer. Patients (n = 10) with stage IV lung cancer, received VV-PISH (>or= 42 degrees C to <or= 42.5 degrees C) for 120 minutes. General anesthesia, spontaneous ventilation, and heparinization allowed for percutaneous central venous access. The ThermoChem HT system provided extracorporeal blood flow (1000 to 1340 mL/min), used a calculated average core temperature for feedback control of blood heating, and included a charcoal-based sorbent for electrolyte homeostasis. The first three patients helped in refining the technique and reflect an evolutionary process, therefore their data are not included as part of the VV-PISH cohort. Venovenous perfusion-induced systemic hyperthermia (n = 7) had a preoperative weight loss of 4.4 +/- 2.8 Kg, and a Karnofsky score of >or= 70. Time to target temperature was 47 +/- 2 minutes, as electrolytes remained normal, without patient or circuit complications. Extubation occurred between 6 and 18 hours. Hospital stay was 4.6 +/- 1.1 days; median length-of-survival after hyperthermia was 271 days. For concurrent controls (n = 16, stage IV lung cancer), median length-of-survival from time of diagnosis to death was 96 days, but for the VV-PISH patients it was significantly longer at 450 days (p < 0.05). All patients returned to pretreatment status following treatment and died from progression of lung cancer. Venovenous perfusion-induced systemic hyperthermia is safe, technically feasible, and achieves target temperature. Survival may be enhanced in stage IV lung cancer.