ISOLATED LUNG PERFUSION WITH PLATINUM IN THE TREATMENT OF PULMONARY METASTASES FROM SOFT-TISSUE SARCOMAS

A multimodality approach including operation and isolated lung perfusi on with platinum was used in six patients with lung metastases from so ft tissue sarcomas, Staged thoracotomies were used in two patients wit h bilateral lesions. The inclusion criteria generally applied for surg ical excision were adopted in this study, The pulmonary artery and a p ortion of the left atrium were isolated from systemic circulation and cannulated, The cannulas were then connected to a perfusion circuit an d normothermic isolated lung perfusion was done for 60 minutes. The lu ng was then flushed and metastasectomy was done, Serial blood (systemi c and pulmonary), tissue (normal lung and tumor), and urine samples we re obtained for platinum content measurement by flameless atomic absor ption spectroscopy, Lung damage was assessed by light and electron mic roscopy examination and by serial respiratory tests. Isolated lung per fusion was accomplished in all patients without any death, operative c omplication, or systemic toxicity. After operation, interstitial and a lveolar edema developed in two patients (48 hours after treatment), ne cessitating respiratory support in one case. Total platinum concentrat ions in pulmonary plasma were about 43 times greater than those in sys temic plasma, No differences in platinum concentrations between normal lung and metastatic tissue were found, Thus the proposed isolated lun g perfusion technique is feasible and safe enough to be offered as a v alid model to study combined chemosurgical approaches in the treatment of lung metastases.