Isolated lung perfusion: single-pass system versus recirculating blood perfusion in pigs

Area of Science:

• Oncology
• Surgical Oncology
• Pharmacology

Background:

• Pulmonary metastasis of soft tissue sarcoma is a clinical challenge.
• Cytostatic isolated lung perfusion (ILP) is a promising treatment strategy.
• Various ILP techniques exist, necessitating comparative analysis.

Purpose of the Study:

• To compare the efficacy and safety of single-pass versus recirculating-blood isolated lung perfusion (ILP) for doxorubicin delivery.
• To assess doxorubicin concentration in lung tissue and plasma.
• To evaluate perfusion-induced lung injury in a porcine model.

Main Methods:

• White pigs underwent 15-minute isolated lung perfusion with or without doxorubicin using single-pass or recirculating-blood systems.
• Control animals received endovenous doxorubicin.
• Leakage, lung tissue injury (wet-to-dry ratio, histology, ACE/protein ratio), and doxorubicin concentration were assessed.

Main Results:

• Both ILP techniques achieved significantly higher lung doxorubicin concentrations (6-7 fold) compared to endovenous application.
• Single-pass ILP demonstrated a significantly lower wet-to-dry weight ratio, indicating less lung edema.
• No significant differences in histological lung injury or systemic leakage were observed between ILP groups.

Conclusions:

• Isolated lung perfusion significantly enhances lung doxorubicin tissue concentration compared to systemic delivery.
• Single-pass ILP is a viable alternative to recirculating-blood ILP, offering comparable drug delivery with reduced acute lung injury and technical complexity.
• ILP shows potential for targeted chemotherapy delivery in pulmonary metastasis treatment.