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Ann Thorac Surg 2004;77:1916-1925
© 2004 The Society of Thoracic Surgeons

Original article: general thoracic

Percutaneous venovenous Perfusion-Induced systemic hyperthermia for lung cancer: a phase I safety study

Joseph B. Zwischenberger, MDa*, Roger A. Vertrees, PhDa, Eric A. Bedell, MDb, Christopher K. McQuitty, MDb, Jill M. Chernin, RNa, Lee C. Woodson, MD, PhDb

a Department of Surgery, The University of Texas Medical Branch, Galveston, Texas, USA
b Department of Anesthesia, The University of Texas Medical Branch, Galveston, Texas, USA

Accepted for publication October 30, 2003.

* Address reprint requests to Dr Zwischenberger, Division of Cardiothoracic Surgery, Department of Surgery, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77551-0528, USA
e-mail: jzwische{at}utmb.edu

Presented at the Forty-ninth Annual Meeting of the Southern Thoracic Surgical Association, Miami Beach, FL, Nov 7–9, 2002.

BACKGROUND: Veno-venous perfusion-induced systemic hyperthermia (VV-PISH) homogeneously raises core body temperature potentially improving outcomes from metastatic lung cancer.

METHODS: Patients (n = 10) with stage IV lung cancer, received VV-PISH (≥ 42°C to ≤ 42.5°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.

RESULTS: 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 ≥ 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.

CONCLUSIONS: Venovenous perfusion-induced systemic hyperthermia is safe, technically feasible, and achieves target temperature. Survival may be enhanced in stage IV lung cancer.






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