Percutaneous venovenous perfusion-induced systemic hyperthermia for advanced non-small cell lung cancer: Initial clinical experience

Background. Venovenous perfusion-induced systemic hyperthermia raises core body temperature by extracorporeal heating of the blood. Five patients with advanced non-small cell lung carcinoma stage IV (4.4 +/- 1 months after in itial diagnosis) received venovenous perfusion-induced systemic hyperthermi a to 42.5 degreesC (core temperature) to assess technical and patient risks . Methods. After general anesthesia and systemic heparinization (activated cl otting time > 300 seconds), percutaneous cannulation of the right internal jugular vein (15F) for drainage and common femoral vein (15F) for reinfusio n allowed extracorporeal flow rates up to 1,500 mL/min (20 mL.kg(-1).min(-1 )) with the ThermoChem System. This device uses charcoal-based sorbent for electrolyte homeostasis. Six monitored sites (rectal, bladder, tympanic x2, nasopharyngeal, and esophageal) determined average core temperature. Results. All patients achieved a core target temperature of 42.5 degreesC f or 2 hours. Electrolyte balance was maintained throughout hyperthermia (mea n) in mmol/L: Na+, 136.2 +/- 2.2 mmol/L; K+, 4.0 +/- 0.3 mmol/L; Ca2+, 4.1 +/- 0.2 mg/dL; Mg2+, 1.9 +/- 0.1 mg/dL; PO4-, 4.5 +/- 0.9 mg/dL). Plasma cy tokine concentration revealed significant hfatinduced activation of proinfl ammatory and antiinflammatory cascades. All patients exhibited systemic vas odilation requiring norepinephrine infusion, 4 of 5 patients required vigor ous diuresis, and 3 of 5 required intubation for 24 to 36 hours because of pulmonary edema or somnolence, with full recovery. Average! length of hospi tal stay was 5.4 days. Serial tumor measurements (1 patient withdrew) revea led a decrease (64.5% +/- 18%) in tumor size in 2 patients, no change in 1, and enlargement in 1, with no 30-day mortality. Median survival after hype rthermia treatment was 172 days (lange, 40 to 271 days). Conclusions. Venovenous perfusion-induced systemic hyperthermia is feasible and provides the following potential advantages for better tumoricidal eff ect: (1) homogeneous heating, and (2) a higher sustained temperature. (C) 2 001 by The Society of Thoracic Surgeons.