ABSTRACT
Isolated lung perfusion The lung is the primary site for metastasis from extremity lesions and is often the solitary site. While resection is the preferred approach when possible, many patients cannot undergo pulmonary resection, and those that do have a high probability of further recurrence in the lung. Isolated lung perfusion has been investigated since the late 1950s.1 This approach is theoretically very attractive for patients with metastatic sarcoma in efforts to eradicate all disease with high-dose chemotherapeutic agents. A recent report from our group established the maximum tolerated dose of adriamycin in isolated lung perfusion to be 40 mg/m2. Doses in excess of this are accompanied by unacceptable toxicity.2 This approach, although done in a phase I setting, did not show significant response, except in a single patient (12%). However, the technique of isolated lung perfusion is an ideal one for the investigation of new biological agents and, indeed, of other chemotherapeutic agents. As well as being a therapeutic approach for unresectable disease, isolated lung perfusion can serve as an adjuvant for patients who have already undergone resection. The majority of these tumors will recur, and the majority of these will recur in the lung. At present, no significant effect has been shown from isolated lung perfusion, but it remains a model with
potential for testing biological agents or other chemotherapeutic agents whose systemic toxicity at this dosage is unacceptable.
