Typical CT and X-ray semiotics of pulmonary edema after isolated lung perfusion with melphalan or cisplatin and metastases resection

Congress:

ECR 2019

Poster Number:

C-0485

Type:

Scientific Exhibit

Keywords:

Oedema, Drugs / Reactions, Cancer, Complications, Chemotherapy, CT, Oncology, Lung

Authors:

P. S. Kalinin¹, A. Mishchenko², E. Levchenko³, K. Senchik³, O. Mamontov³, E. Gubatova³, T. Dubinina³, Z. Wen³, W. Ting³; ¹Saint-Petrsburg,/RU, ²St.Petersburg/RU, ³Saint-Petrsburg/RU

DOI:

10.26044/ecr2019/C-0485

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-0485

Fig. 1: Chest X-ray. 2 day after isolated perfusion with cisplatin of right lung. No...

Fig. 2: Chest CT. 3 day after isolated perfusion with cisplatin of right lung. No signs...

Fig. 3: Chest X-ray. 2 day after isolated perfusion with cisplatin of left lung....

Fig. 4: Chest CT. 3 day after isolated perfusion with cisplatin of left lung....

Aims and objectives

Pulmonary metastases occur in approximately 30% of patients dying of cancer. The 5-years overall survival of patients with pulmonary metastases after complete resection range between 20-40% [5]. One of the reasons for this rather poor survival rate is the high rate of local recurrence in the operated lung (from 43% to 66%) [5]. Poor results of systemic chemotherapy and surgical resection of pulmonary metastases are probably due the inability to achieve effective drug concentrations within the lung [1, 4]. Isolated lung perfusion is a surgical...

Methods and materials

From 2007 to 2014, 74 patients with pulmonary metastases of different types of cancer were included in our study. 14 (18.9%) patients had pulmonary metastases from soft-tissue sarcoma, 13 (17.6%) – colorectal carcinoma, 11 (14.9%) patients - osteosarcoma, 8 (10.8%) - kidney, 4 (5.4%) – breast cancer, 3 (4.1%) – melanoma, 21 (28.3%) – other. 101 isolated lung perfusion procedures were performed. If bilateral disease was present (43 (58.1%) patients), a staged bilateral thoracotomy took place within a period of 6-24 weeks. All 101 isolated...

Results

Pulmonary edema detected after 31 (30.7%) procedures and was unilateral (100%) (fig. 1, fig. 2). Pulmonary edema was more often detected after isolated lung perfusion with cisplatin than with melphalan (p < 0.005); pulmonary edema was detected in 7 cases after isolated lung perfusion with melphalan and 24 cases after isolated lung perfusion with cisplatin. We identified 3 types of pulmonary edema after isolated lung perfusion: interstitial edema, mixed edema, alveolar edema. Interstitial edema was detected after 9 (29.0%) procedures and manifested itself in interlobular...

Conclusion

Pulmonary edema is a frequent complication after isolated lung perfusion. The most common manifestation of pulmonary edema is mixed edema.

Personal information

References

1. Burt M. Isolated lung perfusion for patients with unresectable metastases from sarcoma: a phase I trial. The Annals of Thoracic Surgery 2000; 69:1542–1549. 2. Cypel M., Keshavjee Sh. Isolated lung perfusion. Frontiers in Bioscience 2012; 4:2226-2232. 3. Hendriks J.M., Grootenboers M.J., Schramel F.M. et. Isolated lung perfusion with melphalan for resectable lung metastases: a phase I clinical trial. The Annals of Thoracic Surgery 2004; 6:1919-1926. 4. Hengst W.A., Hendriks J.M., Balduyck B. et al. Phase II multicenter clinical trial of pulmonary metastasectomy and isolated...