Objectives: We sought to document interim methodologic improvements and preliminary results for pulmonary suffusion.Methods: A Phase I/II trial of thoracoscopic lung suffusion for resectable sarcoma and colorectal carcinoma metastases followed a pilot study on oligometastatic lung malignancy at a comprehensive cancer center. Primary-specific chemotherapy doses (cisplatin, oxaliplatin, doxorubicin, or gemcitabine) suffused unilaterally for 30 min were escalated to amplify regional deliveries three-fold. Drug delivery was measured with tissue, blood samples, and99Tc; pulmonary function tests and clinical adverse events (AEs) assessed safety and tolerance.Results: From 2008–2025, 31 ECOG 0–2 patients (10 male) aged 33–75 years had unilateral lung suffusion (16 right, 14 left, 1 aborted, and 8 sides selected randomly). Vascular occlusion intolerance was immediate or delayed (25 min) in two cases. Two catheter-positioning grade 3 AEs occurred: hypotension with troponin leak (1) and atrial fibrillation (1). Patients averaged 1.3 ± 1.2 metastasectomies (17 sub-lobar, 8 lobar resections, and 2 intentional open cytoreductive metastasectomies). Hospitalizations were brief (1–4 days) except for 6–7 day stays in the only two open cases and one doxorubicin (grade 4 hypoxic respiratory failure) case. Ninety-day survival was 100%, and the Phase I delivery goal of 12.75 mg/m265 (15% systemic) was achieved for oxaliplatin. Lung function was preserved according to99Tc differentials within 6.1 ± 7.1% of the predicted reductions at 30 days. Sampling delays, tracer discordances, and atypical pharmacokinetics reduced tissue drug detections. Recent pulmonary artery snaring cases (two) demonstrated in-flow control more stable than that of balloon occlusions.Conclusions: Suffusion for metastatic malignancies appears safe and warrants further investigation.
目的：本研究旨在记录肺灌注技术的阶段性方法学改进及初步结果。方法：在一项针对寡转移性肺部恶性肿瘤的初步研究基础上，某综合癌症中心开展了胸腔镜肺灌注治疗可切除肉瘤及结直肠癌转移灶的I/II期临床试验。通过逐步提升原发灶特异性化疗药物（顺铂、奥沙利铂、多柔比星或吉西他滨）的单侧30分钟灌注剂量，使区域药物输送量提升三倍。采用组织样本、血液样本及锝-99标记技术评估药物输送效率，通过肺功能测试和临床不良事件（AEs）评估安全性与耐受性。结果：2008年至2025年间，31例ECOG评分0-2分、年龄33-75岁的患者（男性10例）接受单侧肺灌注治疗（右侧16例，左侧14例，1例中止，8侧随机选择）。两例出现血管闭塞不耐受（即时或延迟25分钟发生）。发生两例3级导管定位相关不良事件：伴肌钙蛋白渗漏的低血压（1例）和心房颤动（1例）。患者平均接受1.3±1.2次转移灶切除（17例亚肺叶切除，8例肺叶切除，2例计划性开胸减瘤转移灶切除）。除仅有的两例开胸手术及一例多柔比星（4级低氧性呼吸衰竭）病例住院6-7天外，其余住院时间均较短（1-4天）。90天生存率达100%，奥沙利铂达到I期12.75 mg/m²的输送目标（全身暴露量15%）。根据锝-99差异分析，30天时肺功能保持良好，实测下降值较预测值偏差仅6.1±7.1%。样本延迟、示踪剂不一致及非典型药代动力学降低了组织药物检出率。近期两例肺动脉套扎病例显示其血流控制稳定性优于球囊闭塞术。结论：转移性恶性肿瘤的灌注治疗安全性良好，值得进一步研究。
肿瘤(癌症)患者之家