Updates in Surgery

, Volume 71, Issue 1, pp 165–177 | Cite as

Isolated thoracic perfusion in lung metastases from breast cancer: a retrospective observational study

  • Stefano GuadagniEmail author
  • Karl Aigner
  • Odisseas Zoras
  • Francesco Masedu
  • Giammaria Fiorentini
  • Enrico Ricevuto
  • Marcello Deraco
  • Marco Clementi
Original Article


The median overall survival of metastatic breast cancer (MBC) patients is still approximately 2 years. This is even lower in triple-negative breast cancer (TNBC) patients with concomitant lung metastases. These patients are often not suitable for surgery and not responsive to systemic chemotherapy. Isolated thoracic perfusion (ITP) followed by chemofiltration has been used for palliation in selected specialised centres. A retrospective observational study evaluating 162 MBC patients who underwent 407 ITP procedures was performed. The primary objective was the evaluation of the feasibility, safety, tolerability and efficacy of ITP in the complete cohort of 162 patients with LM from breast cancer. The secondary objective of the study was the evaluation of responses and median survivals in 43 TNBC patients with LM. In the 162 patients, ITP appeared safe and well tolerated with MST from LM diagnosis to death or last contact of 19.5 months. In the subgroup of patients treated with systemic chemotherapy followed by ITP at progression, the MST from LM diagnosis to death or last contact was 29 months. In the subgroup of TNBC patients treated with systemic chemotherapy followed by ITP at progression, the MST from LM diagnosis to death or last contact was 19 months (ITP overall response rate was 65.52%). ITP followed by chemofiltration could be adopted in the sequential palliation treatments of BC patients with LM in progression after systemic chemotherapy, especially with TNBC. The present data allow interesting considerations about tolerability and responses, but do not allow robust conclusions about survival.


Breast cancer Lung metastases Triple-negative status Isolated thoracic perfusion 



We would like to thank Giancarlo Palumbo (University of L’Aquila, Italy) for pharmacokinetic analyses, Kornelia Aigner (Department of Surgical Oncology, Medias Klinikum, Burghausen, Germany) and Gianni Lazzarin (University of L’Aquila, Italy) for data collection, Lucio Fumi (Wyfold Medical Consultancy, Oxford, UK) for English editing, and Società Italiana di Terapie Integrate Locoregionali in Oncologia (SITILO) for scientific support.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this paper.

Research involving human participants and/or animals

This retrospective observational study had been conducted in accordance with the ethical standards of the Committee on Human Experimentation, after approval of the Ethics Committee in L’Aquila (n.10/CE/2018), and according to all rules for good clinical practice included in the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in this study.


  1. 1.
    Cardoso F, Costa A, Senkus E et al (2017) 3rd ESO-ESMO international consensus guidelines for Advanced Breast Cancer (ABC 3). Breast 31:244–259CrossRefGoogle Scholar
  2. 2.
    Senkus E, Łacko A (2017) Over-treatment in metastatic breast cancer. Breast 31:309–317CrossRefPubMedGoogle Scholar
  3. 3.
    Brackstone M, Fletcher GG, Dayes ISA et al (2015) Locoregional therapy of locally advanced breast cancer: a clinical practice guideline. Curr Oncol 22(Suppl 1):S54–S66. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Gennari A, Stockler M, Puntoni M et al (2011) Duration of chemotherapy for metastatic breast cancer: a systematic review and meta-analysis of randomized clinical trials. J Clin Oncol 29:2144–2149CrossRefGoogle Scholar
  5. 5.
    Foulkes WD, Smith IE, Reis-Filho JS (2010) Triple-negative breast cancer. N Engl J Med 363:1938–1948CrossRefGoogle Scholar
  6. 6.
    Zeichner SB, Terawaki H, Gogineni K (2016) A review of systemic treatment in metastatic triple-negative breast cancer. Breast Cancer Basic Clin Res 10:25–63CrossRefGoogle Scholar
  7. 7.
    Aigner KR, Guadagni S, Zavattieri G (2016) Regional chemotherapy for thoracic wall recurrence and metastasized breast cancer. In: Aigner KR, Stephens FO (eds) Induction chemotherapy. Systemic and locoregional. Springer-Verlag, Berlin, pp 173–186Google Scholar
  8. 8.
    Guadagni S, Clementi M, Valenti M et al (2006) Thoracic stop-flow perfusion in the treatment of refractory malignant pleural mesothelioma: a phase I-II evaluation/trial. In Vivo 20:715–718PubMedGoogle Scholar
  9. 9.
    Aigner KR, Selak E, Gailhofer S (2017) Isolated thoracic perfusion with chemofiltration for progressive malignant pleural mesothelioma. OncoTargets Ther 10:3049–3057CrossRefGoogle Scholar
  10. 10.
    Guadagni S, Muller H, Valenti M et al (2004) Thoracic stop-flow perfusion in the treatment of refractory non-small cell lung cancer. J Chemother 16(5):40–43CrossRefPubMedGoogle Scholar
  11. 11.
    Ruscitti C, Guadagni S, Russo F et al (2009) Thoracic stopflow perfusion for refractory lymphoma: a phase I-II evaluation trial. In Vivo 23:447–458PubMedGoogle Scholar
  12. 12.
    Muller H, Guadagni S (2008) Regional chemotherapy for carcinoma of the lung. Surg Oncol Clin N Am 17:895–917CrossRefPubMedGoogle Scholar
  13. 13.
    Varrassi G, Guadagni S, Ciccozzi A et al (2004) Hemodynamic variations during thoracic and abdominal stop-flow regional chemotherapy. Eur J Surg Oncol 30:377–383CrossRefPubMedGoogle Scholar
  14. 14.
    Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response valuation criteria in solid tumors: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRefGoogle Scholar
  15. 15.
    Guadagni S, Fiorentini G, Clementi M, Palumbo P, Mambrini A, Masedu F (2017) Mitomycin C hypoxic pelvic perfusion for unresectable recurrent rectal cancer: pharmacokinetic comparison of surgical and percutaneous techniques. Updates Surg 69:403–410. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Zhang Y, Huo M, Zhou J, Xie S (2010) PKSolver: an add-in program for pharmacokinetic and pharmacodynamic data analysis in Microsoft Excel. Comput Methods Progr Biomed 99:306–314CrossRefGoogle Scholar
  17. 17.
    Tseng LM, Hsu NC, Chen SC et al (2013) Distant metastasis in triple-negative breast cancer. Neoplasma 60:290–294CrossRefPubMedGoogle Scholar
  18. 18.
    Gadiyaram VK, Kurian S, Abraham J et al (2010) Recurrence and survival after pulmonary metastasis in triple-negative breast cancer. J Clin Oncol 28:15s. (suppl; abstract 1131) CrossRefGoogle Scholar
  19. 19.
    Rugo HS, Barry WT, Moreno-Aspitia A et al (2015) Randomized phase III study of paclitaxel once per week compared with nanoparticle albumin-bound Nab-paclitaxel once per week or ixabepilone with bevacizumab as first-line chemotherapy for locally recurrent or metastatic breast cancer: CALGB 40502/NCCTG N063H (alliance). J Clin Oncol 33:2361–2369CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kaufman PA, Awada A, Twelves C et al (2015) Phase III open-label randomized study of eribulin mesylate versus capecitabine in patients with locally advanced or metastatic breast cancer previously treated with an anthracycline and a taxane. J Clin Oncol 33:594–601CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Maeda S, Saimura M, Minami S et al (2017) Efficacy and safety of eribulin as first- to third-line treatment in patients with advanced or metastatic breast cancer previously treated with anthracyclines and taxanes. Breast 32:66–72CrossRefPubMedGoogle Scholar
  22. 22.
    Wahba HA, El-Hadaad HA (2015) Current approaches in treatment of triple-negative breast cancer. Cancer Biol Med 12:106–116PubMedPubMedCentralGoogle Scholar
  23. 23.
    Tutt A, Ellis P, Kilburn L, et al (2015) The TNT trial: A randomized phase III trial of carboplatin © compared with docetaxel (D) for patients with metastatic or recurrent locally advanced triple negative or BRCA1/2 breast cancer (CRUK/07/012) [abstract]. In: Proceedings of the thirty-seventh annual CTRC-AACR San Antonio breast cancer symposium: 2014 Dec 9–13; San Antonio, TX. Philadelphia (PA): AACR. Cancer Res 75 (9 Suppl): Abstract nr S3-01Google Scholar
  24. 24.
    Fiorentini G, Poddie DB, Cantore M et al (2004) Hepatic intra-arterial chemotherapy (HIAC) of high dose mitomycin and epirubicin combined with caval chemofiltration versus prolonged low doses in liver metastases from colorectal cancer: a prospective randomised study. J Chemother 16:51–54CrossRefPubMedGoogle Scholar
  25. 25.
    Guadagni S, Clementi M, Valenti M et al (2007) Hypoxic abdominal stop-flow perfusion in the treatment of advanced pancreatic cancer: a phase II evaluation/trial. Eur J Surg Oncol 33:72–78CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2018

Authors and Affiliations

  1. 1.Department of Applied Clinical Sciences and BiotechnologyUniversity of L’AquilaL’AquilaItaly
  2. 2.Department of Surgical OncologyMedias KlinikumBurghausenGermany
  3. 3.Department of Surgical OncologyUniversity of CreteHeraklionGreece
  4. 4.Department of Oncology and HematologyOspedali Riuniti Marche NordPesaroItaly
  5. 5.Peritoneal Surface Malignancies Unit, Colon and Rectal SurgeryFondazione IRCCS Istituto Nazionale TumoriMilanItaly
  6. 6.Department of Life, Health and Environmental SciencesUniversity of L’AquilaL’AquilaItaly

Personalised recommendations