Local and systemic exposure of cisplatin during hyperthermic intrathoracic chemotherapy perfusion after pleurectomy and decortication for treatment of pleural malignancies

Background Assessing the pharmacokinetics of intrapleurally administered cisplatin during hyperthermic intrathoracic chemotherapy perfusion (HITHOC) following pleurectomy/decortication in patients with malignant pleural mesothelioma or advanced thymoma with pleural spread. Methods Pharmacokinetic analysis (ICP-MS) of intrapleural cisplatin with a dosage of 100mg/m2 (n=5) or 150mg/m2 (n=5) at 42 degrees C perfusate temperature. Simultaneous pleural perfusion fluid and serum samples were collected at the beginning and every 15min. Serum samples were collected at the end of the operation, 6, 12, and 24hr postoperative. Results Mean cisplatin levels in the perfusate slightly decreased during the HITHOC. The mean area under the curve ratios (AUCperfusate:AUCserum) of cisplatin were nearly similar. The mean AUCs of cisplatin in the perfusate were approximately 58 and 55 times greater than detected in the serum. The mean peak of cisplatin in the serum was reached after 1hr of HITHOC. The AUC of cisplatin in the serum did not significantly differ (P=0.18) between both groups up to 24hr after perfusion. Conclusions HITHOC with cisplatin provides a pharmacological advantage of high local intrapleural cisplatin concentrations. Elevation of the cisplatin dosage to 150mg/m2 did not lead to a significant increase of the systemic cisplatin concentration. J. Surg. Oncol. 2013;107:735740. (c) 2013 Wiley Periodicals, Inc.