LUNG PERFUSION WITH CHEMOTHERAPY IN PATIENTS WITH UNRESECTABLE METASTATIC SARCOMA TO THE LUNG OR DIFFUSE BRONCHIOLOALVEOLAR CARCINOMA

Eight patients with metastatic sarcoma to the lung (n = 4) or diffuse bronchioloalveolar carcinoma of the lung (n = 4) underwent isolated lu ng perfusion with chemotherapy in a pilot study. Ages ranged from 18 t o 60 years and half were female. The left lung was perfused in three p atients (single lung perfusion) and both lungs in five patients (total lung perfusion). Perfusions ranged from 45 to 60 minutes at ambient o r normothermic temperatures. One patient received perfusion at moderat e hyperthermia (40 degrees C). Escalating doses of doxorubicin (1 to 1 0 mu g/ml perfusate) was used in six patients, whereas two received ci splatin (14 and 20 mu g/ml perfusate). There were two major complicati ons and no objective responses. The isolated perfusion systems gave ex cellent separation between systemic and pulmonary circulations with ze ro to 15% of the measured peak drug concentration of the pulmonary per fusate detected in the systemic circulation. Drug concentrations in no rmal lung and tumor generally increased with higher drug dosages and d rug was detectable in mediastinal lymph nodes of three out of four pat ients in whom sampling was done. Isolated lung perfusion with chemothe rapy can be done safely in patients with lung malignancies and evidenc e suggests that higher drug dosages should be well tolerated.