Hyperthermic Intrapleural Chemotherapy in Pleural Malignancy.

Hyperthermic intrapleural chemotherapy for malignant pleural disease aims to increase the exposure of malignant cells at the pleural surface to chemotherapeutic agents. Evidence is presented that indeed intrapleural perfusion can result in local exposure for cisplatin and doxorubicin of 60 to 100 times the systemic exposure. Combining chemotherapeutic perfusion of the pleural cavity with mild hyperthermia of 40°-42°C can probably further increase effective tumor cell kill. Effective penetration of the drugs is limited, however. This type of therapy can therefore only work in cases of microscopic residual disease, after complete surgical resection of all malignant pleural disease. A review is presented of studies using this approach in malignant pleural mesothelioma and in pleural involvement in non-small cell lung cancer. In neither disease is there any solid evidence to prove effectivness of hyperthermic pleural chemotherapy. Only in patients with pleural metastases of malignant tymoma has this approach resulted in some unexpected long-term survivors. [ABSTRACT FROM AUTHOR]