BJMO - volume 9, issue 1, february 2015
W. Den Hengst MD, J. Hendriks MD, PhD, F. Lardon PhD, P. Van Schil MD, PhD
The golden standard for the treatment of lung metastases remains complete surgical resection. Prognostic factors for patients with lung metastases are histology, number of metastases and disease-free interval. However, the chance of recurrent disease in the treated lung remains high after complete resection, even in combination with systemic chemotherapy. Systemic toxicity limits the dose of the latter, resulting in only limited local pulmonary control. Therefore, new techniques are developed to deliver a high-dose of chemotherapy selectively into the lung, reducing the risk of systemic toxicity. One of these techniques is isolated lung perfusion, which is comparable with isolated limb perfusion. This experimental surgical technique allows delivery of a very high-dose of chemotherapy with or without biological response modifiers to the lung, without the risk of systemic exposure. Experimental studies with this technique have shown its superiority in achieving higher tissue concentrations of chemotherapy in the target organ as well as improved survival in comparison with systemic chemotherapy. As shown in several phase I studies, this technique is technically feasible with minimal morbidity and minimal impact on pulmonary function. In a recent phase II study, an improved local pulmonary control was found in comparison with the literature. This review discusses the current status of isolated lung perfusion as well as newer, less invasive techniques to deliver high-dose chemotherapy selectively to the lung.
(BELG J MED ONCOL 2015;9(1):5–10)Read more
BJMO - volume 8, issue 5, december 2014
B. Hiddinga MD, P. Van Schil MD, PhD, J. Van Meerbeeck MD, PhD
Malignant pleural mesothelioma remains a lethal disease and its incidence is expected to increase until the 2020’s. Disease extent and performance status at diagnosis are the clinical prognostic factors, besides epithelioid subtype which confers a better outcome than the less common sarcomatoid one. Currently, only administration of palliative chemotherapy has a proven impact on outcome. Treatment of early stage malignant pleural mesothelioma should be offered in a multimodality setting, including at least a systemic and a locoregional treatment. The role of radical surgery remains controversial. Optimal treatment schedules are not defined yet. The standard first line palliative treatment consists of platinum in combination with an antifolate, either pemetrexed or raltitrexed. As the outcome in first line remains modest, it is ethical to include these patients in clinical trials comprising a chemotherapy backbone. For maintenance therapy there’s still no standard in malignant pleural mesothelioma. In second line treatment, referral of patients for inclusion in trials is highly recommended.
(BELG J MED ONCOL 2014;8(5):197–205)Read more