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Ann Thorac Surg 1997;63:799
© 1997 The Society of Thoracic Surgeons

Invited Commentary

Michael R. Johnston, MD

Division of Thoracic Surgery Mount Sinai Hospital University of Toronto 600 University Ave, Rm 1525 Toronto, ON M5G 1X5 Canada

See also page 796.

Isolated lung perfusion as a method of administering anticancer therapy is slowly evolving since my colleagues and I brought it into the modern era of thoracic surgery more than 10 years ago. Lung perfusion neatly weds the technology of cardiopulmonary bypass and the physiology of lung preservation/transplantation with real therapeutic problems in thoracic oncology. Patients with both metastatic sarcoma and brochioloalveolar carcinoma stand to benefit from this approach, if it is successful. The procedural aspects of lung perfusion are actually quite simplistic, but assessing the best drugs, the role of biological response modifiers, and the optimal physical conditions will take time and the effort of many investigators to sort out.

Doctor Burt and his co-workers have developed a rat model to test various therapies. In this latest article they describe bilateral sequential perfusions, an obvious necessity for successful clinical application of this technique. This model will certainly help demonstrate efficacy of a proposed therapy by allowing them to measure survival, in addition to response. However, unless they introduce into their studies more sophisticated lung physiologic measurements than body weight and terminal blood gas analysis, it will be difficult to judge the pattern and degree of injury caused by a therapy. If results from these studies are to influence the design of clinical trials, without intervening large-animal toxicity data, then the potential lung derangements caused by a given therapy should be well documented.


Related Article

Sequential Bilateral Isolated Lung Perfusion in the Rat: An Experimental Model
Sumihiko Nawata, Amir Abolhoda, Howard M. Ross, Ari Brooks, and Michael E. Burt
Ann. Thorac. Surg. 1997 63: 796-799. [Abstract] [Full Text]




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