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

Joseph B. Zwischenberger, Roger A. Vertrees, Lee C. Woodson, Eric A. Bedell, Scott K. Alpard, Christopher McQuitty, Jill M. Chernin

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Abstract

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 initial diagnosis) received venovenous perfusion-induced systemic hyperthermia to 42.5°C (core temperature) to assess technical and patient risks. Methods. After general anesthesia and systemic heparinization (activated clotting time > 300 seconds), percutaneous cannulation of the right internal jugular vein (15F) for drainage and common femoral vein (15F) for reinfusion 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 ×2, nasopharyngeal, and esophageal) determined average core temperature. Results. All patients achieved a core target temperature of 42.5°C for 2 hours. Electrolyte balance was maintained throughout hyperthermia (mean) 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 cytokine concentration revealed significant heat-induced activation of proinflammatory and antiinflammatory cascades. All patients exhibited systemic vasodilation requiring norepinephrine infusion, 4 of 5 patients required vigorous diuresis, and 3 of 5 required intubation for 24 to 36 hours because of pulmonary edema or somnolence, with full recovery. Average length of hospital stay was 5.4 days. Serial tumor measurements (1 patient withdrew) revealed 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 hyperthermia treatment was 172 days (range, 40 to 271 days). Conclusions. Venovenous perfusion-induced systemic hyperthermia is feasible and provides the following potential advantages for better tumoricidal effect: (1) homogeneous heating, and (2) a higher sustained temperature.

Original languageEnglish (US)
Pages (from-to)234-242
Number of pages9
JournalAnnals of Thoracic Surgery
Volume72
Issue number1
DOIs
StatePublished - 2001

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Induced Hyperthermia
Non-Small Cell Lung Carcinoma
Perfusion
Temperature
Heating
Length of Stay
Fever
Water-Electrolyte Balance
Femoral Vein
Charcoal
Diuresis
Jugular Veins
Pulmonary Edema
Body Temperature
Intubation
Vasodilation
Catheterization
General Anesthesia
Electrolytes
Drainage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Percutaneous venovenous perfusion-induced systemic hyperthermia for advanced non-small cell lung cancer : Initial clinical experience. / Zwischenberger, Joseph B.; Vertrees, Roger A.; Woodson, Lee C.; Bedell, Eric A.; Alpard, Scott K.; McQuitty, Christopher; Chernin, Jill M.

In: Annals of Thoracic Surgery, Vol. 72, No. 1, 2001, p. 234-242.

Research output: Contribution to journalArticle

Zwischenberger, Joseph B. ; Vertrees, Roger A. ; Woodson, Lee C. ; Bedell, Eric A. ; Alpard, Scott K. ; McQuitty, Christopher ; Chernin, Jill M. / Percutaneous venovenous perfusion-induced systemic hyperthermia for advanced non-small cell lung cancer : Initial clinical experience. In: Annals of Thoracic Surgery. 2001 ; Vol. 72, No. 1. pp. 234-242.
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abstract = "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 initial diagnosis) received venovenous perfusion-induced systemic hyperthermia to 42.5°C (core temperature) to assess technical and patient risks. Methods. After general anesthesia and systemic heparinization (activated clotting time > 300 seconds), percutaneous cannulation of the right internal jugular vein (15F) for drainage and common femoral vein (15F) for reinfusion 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 ×2, nasopharyngeal, and esophageal) determined average core temperature. Results. All patients achieved a core target temperature of 42.5°C for 2 hours. Electrolyte balance was maintained throughout hyperthermia (mean) 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 cytokine concentration revealed significant heat-induced activation of proinflammatory and antiinflammatory cascades. All patients exhibited systemic vasodilation requiring norepinephrine infusion, 4 of 5 patients required vigorous diuresis, and 3 of 5 required intubation for 24 to 36 hours because of pulmonary edema or somnolence, with full recovery. Average length of hospital stay was 5.4 days. Serial tumor measurements (1 patient withdrew) revealed 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 hyperthermia treatment was 172 days (range, 40 to 271 days). Conclusions. Venovenous perfusion-induced systemic hyperthermia is feasible and provides the following potential advantages for better tumoricidal effect: (1) homogeneous heating, and (2) a higher sustained temperature.",
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AU - Zwischenberger, Joseph B.

AU - Vertrees, Roger A.

AU - Woodson, Lee C.

AU - Bedell, Eric A.

AU - Alpard, Scott K.

AU - McQuitty, Christopher

AU - Chernin, Jill M.

PY - 2001

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N2 - 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 initial diagnosis) received venovenous perfusion-induced systemic hyperthermia to 42.5°C (core temperature) to assess technical and patient risks. Methods. After general anesthesia and systemic heparinization (activated clotting time > 300 seconds), percutaneous cannulation of the right internal jugular vein (15F) for drainage and common femoral vein (15F) for reinfusion 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 ×2, nasopharyngeal, and esophageal) determined average core temperature. Results. All patients achieved a core target temperature of 42.5°C for 2 hours. Electrolyte balance was maintained throughout hyperthermia (mean) 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 cytokine concentration revealed significant heat-induced activation of proinflammatory and antiinflammatory cascades. All patients exhibited systemic vasodilation requiring norepinephrine infusion, 4 of 5 patients required vigorous diuresis, and 3 of 5 required intubation for 24 to 36 hours because of pulmonary edema or somnolence, with full recovery. Average length of hospital stay was 5.4 days. Serial tumor measurements (1 patient withdrew) revealed 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 hyperthermia treatment was 172 days (range, 40 to 271 days). Conclusions. Venovenous perfusion-induced systemic hyperthermia is feasible and provides the following potential advantages for better tumoricidal effect: (1) homogeneous heating, and (2) a higher sustained temperature.

AB - 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 initial diagnosis) received venovenous perfusion-induced systemic hyperthermia to 42.5°C (core temperature) to assess technical and patient risks. Methods. After general anesthesia and systemic heparinization (activated clotting time > 300 seconds), percutaneous cannulation of the right internal jugular vein (15F) for drainage and common femoral vein (15F) for reinfusion 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 ×2, nasopharyngeal, and esophageal) determined average core temperature. Results. All patients achieved a core target temperature of 42.5°C for 2 hours. Electrolyte balance was maintained throughout hyperthermia (mean) 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 cytokine concentration revealed significant heat-induced activation of proinflammatory and antiinflammatory cascades. All patients exhibited systemic vasodilation requiring norepinephrine infusion, 4 of 5 patients required vigorous diuresis, and 3 of 5 required intubation for 24 to 36 hours because of pulmonary edema or somnolence, with full recovery. Average length of hospital stay was 5.4 days. Serial tumor measurements (1 patient withdrew) revealed 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 hyperthermia treatment was 172 days (range, 40 to 271 days). Conclusions. Venovenous perfusion-induced systemic hyperthermia is feasible and provides the following potential advantages for better tumoricidal effect: (1) homogeneous heating, and (2) a higher sustained temperature.

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