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Ann Thorac Surg 2003;76:653
© 2003 The Society of Thoracic Surgeons
a Department of Cardiothoracic Surgery, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom
b Department of Oncology and Clinical Pharmacology, Royal Marsden Hospital, Fulham RoadLondon, United Kingdom
c Department of Histopathology, Royal Brompton Hospital, Sydney Street, London, United Kingdom
e-mail: pankajkumar66{at}hotmail.com
To the Editor:
We read the article by Isowa and colleagues [1] with interest. The authors’ report of the Hemi-Plastron Window technique is indeed novel, and it enabled them to deal with the large epitheliod hemangioendothelioma in the cervicothoracic region successfully by extensive en bloc resection. Although we are familiar with the various approaches for tumors located in the cervicothoracic region [2], we wish to add the following, which might have been helpful in the treatment of that patient.
As stated by the authors, epithelioid hemangioendothelioma is a tumor of low-grade malignant potential. It lies within a broad spectrum of tumors of vascular origin, ranging from benign hemangiomas to frankly malignant angiosarcomas, and represents less than 2% of all mediastinal tumors. We recently reported our experience of using alpha 2a-interferon to treat an extensive mediastinal hemangioma. Alpha 2a-interferon is a highly purified recombinant DNA product that is a potent inhibitor of angiogenesis and acts by blocking the action of fibroblast growth factor. Our patient, a 33-year-old man, presented with massive hemoptysis requiring blood transfusion and was subsequently found to have a large diffuse mediastinal hemangioma [3]. The large mediastinal tumor was not considered resectable, as it was encasing the major central airways, esophagus, and several major mediastinal vessels. Therefore, he was treated with alpha 2a-interferon for 6 months, with marked reduction in tumor mass. He subsequently underwent successful surgical resection of the residual mass and remains well 2 years later. Interestingly, histologic examination of the resected mass showed complete regression of capillary proliferation, which was largely replaced by a fibrous stroma.
All tumors of vascular origin, including epithelioid hemangioendothelioma, are characterized by endothelial cell migration and proliferation in the proliferative phase. As the major stimulus for this proliferation is fibroblast growth factor, it is believed that the mechanism of action of alpha 2a-interferon is the inhibition of this stimulus. There is extensive experience with the use of alpha 2a-interferon in the pediatric population; however, its use to treat mediastinal tumors in adults had not been reported previously.
Our experience suggests that for tumors of vascular origin within the thoracic cavity, an induction treatment with alpha 2a-interferon should be considered. This is particularly so when extended resections are necessary for complete resection or when the tumor is initially considered unresectable, as in our case.
References
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