Percutaneous venovenous perfusion-induced systemic hyperthermia for lung cancer: A phase I safety study

Background Veno-venous perfusion-induced systemic hyperthermia (VV-PISH) homogeneously raises core body temperature potentially improving outcomes from metastatic lung cancer. Methods Patients (n = 10) with stage IV lung cancer, received VV-PISH (≥ 42°C to ≤ 42.5°C) for 120 minutes. General anesthesia, spontaneous ventilation, and heparinization allowed for percutaneous central venous access. The ThermoChem HT system provided extracorporeal blood flow (1000 to 1340 mL/min), used a calculated average core temperature for feedback control of blood heating, and included a charcoal-based sorbent for electrolyte homeostasis. Results The first three patients helped in refining the technique and reflect an evolutionary process, therefore their data are not included as part of the VV-PISH cohort. Venovenous perfusion-induced systemic hyperthermia (n = 7) had a preoperative weight loss of 4.4 ± 2.8 Kg, and a Karnofsky score of ≥ 70. Time to target temperature was 47 ± 2 minutes, as electrolytes remained normal, without patient or circuit complications. Extubation occurred between 6 and 18 hours. Hospital stay was 4.6 ± 1.1 days; median length-of-survival after hyperthermia was 271 days. For concurrent controls (n = 16, stage IV lung cancer), median length-of-survival from time of diagnosis to death was 96 days, but for the VV-PISH patients it was significantly longer at 450 days (p < 0.05). All patients returned to pretreatment status following treatment and died from progression of lung cancer. Conclusions Venovenous perfusion-induced systemic hyperthermia is safe, technically feasible, and achieves target temperature. Survival may be enhanced in stage IV lung cancer.