Development of postoperative intrathoracic chemo-thermotherapy for lung cancer with objective of improving local cure.

From April 1985 through March 1988, 24 lung cancer patients with carcinomatous pleuritis were treated with a new combined treatment modality consisting of pulmonary resection and postoperative intrathoracic chemo-thermotherapy (PICT). They consisted of 15 male patients and nine female patients. A majority of the patients (79%%) had adenocarcinoma. The PICT was started 10 to 14 days after the operation. Immediately after a bolus intrathoracic injection of cisplatin (CDDP) 50-100 mg, thermotherapy was carried out using 13.56-MHz or 8.00-MHz radiofrequency waves for 60 minutes. The peripleural temperature was precisely monitored in 20 patients. The temperature was successfully maintained above 42 degrees C for 40 minutes in each of two or three treatment courses in 13 patients, with no complications. However, in the other seven patients the therapy resulted in incomplete treatment because of development of a side effect. Cytologic examination of the pleural effusion, which was performed after the completion of PICT, gave a negative result in 16 of 20 patients examined. The median follow-up period was 16 months. Local relapse was recognized in only three cases who received incomplete treatment or in whom no temperature measurement was performed. The overall survival of the treated patients (n = 24) was significantly prolonged in comparison with a historical control group treated by surgery only (n = 17) or exploratory thoracotomy (n = 11). Of those 17 patients treated by surgery only, ten patients (59%) died of local relapse. These results suggest that this new treatment modality consisting of pulmonary resection and PICT is useful for the treatment of lung cancer patients with carcinomatous pleuritis, especially in the light of improved local control.