Hyperthermic intrathoracic chemotherapy (HITOC) is an additional intraoperative treatment option within the multimodality therapy of pleural malignancies. A chemotherapy perfusion with high-dose cisplatin is performed over a period of 60 min after surgical cytoreduction to improve local tumour control through the eradication of residual tumour cells. Although HITOC is increasingly used, there is only little scientific evidence about the necessary safety measures after HITOC. Therefore, the objective of this study was an analysis of cisplatin excretion via various body fluids after HITOC, with the aim of providing recommendations on occupational health and safety. Five patients undergoing HITOC were included. Before and after the HITOC, as well as during the following days, serum, urine, and bronchial secretion, as well as pleural effusion, were sampled. The platinum levels in the samples were measured using ICP-MS (inductively coupled plasma-mass spectrometry). Immediately after the HITOC, the mean levels of cisplatin increased dramatically in the serum (from 0.79 to 1349 µg/L), urine (from 3.48 to 10,528 µg/g creatinine), and bronchial secretion (from 0.11 to 156 µg/L). Thereafter, the cisplatin levels dropped to 133 µg/L in the serum and 994 µg/g creatinine in the urine within nine days after the HITOC. The AUC ratio shows 59% of the cisplatin being excreted via the urine after 48 h. The sampling of pleural effusion started 24 h after the HITOC, and the cisplatin levels decreased from 618 to 93 µg/L within nine days. Although the cisplatin levels in the body fluids of HITOC patients are much lower compared to patients receiving intravenous chemotherapy, a significant amount of cisplatin is excreted via these body fluids. Consequently, safety precautions must be implemented in the post-HITOC care of patients to avoid occupational exposure to cisplatin.
胸腔热灌注化疗(HITOC)是多模式治疗胸膜恶性肿瘤的一种附加术中治疗选择。在外科细胞减灭术后，进行为期60分钟的高剂量顺铂化疗灌注，以通过清除残留肿瘤细胞来改善局部肿瘤控制。尽管HITOC的应用日益增多，但关于HITOC后必要的安全措施的科学证据却很少。因此，本研究旨在分析HITOC后顺铂通过各种体液的排泄情况，以期为职业健康与安全提供建议。研究纳入了五名接受HITOC的患者。在HITOC前后以及随后的几天内，采集了血清、尿液、支气管分泌物以及胸腔积液样本。使用ICP-MS（电感耦合等离子体质谱法）测量样本中的铂水平。HITOC后，血清（从0.79 µg/L升至1349 µg/L）、尿液（从3.48 µg/g肌酐升至10,528 µg/g肌酐）和支气管分泌物（从0.11 µg/L升至156 µg/L）中的平均顺铂水平立即急剧上升。此后，在HITOC后的九天内，血清中的顺铂水平降至133 µg/L，尿液中的水平降至994 µg/g肌酐。AUC比值显示，48小时后59%的顺铂通过尿液排泄。胸腔积液的采样始于HITOC后24小时，其顺铂水平在九天内从618 µg/L降至93 µg/L。尽管HITOC患者体液中的顺铂水平远低于接受静脉化疗的患者，但仍有大量顺铂通过这些体液排泄。因此，在HITOC后的患者护理中必须采取安全预防措施，以避免职业性接触顺铂。
The Excretion of Cisplatin after Hyperthermic Intrathoracic Chemotherapy
肿瘤(癌症)患者之家