Selective Pulmonary Artery Perfusion With Blood Flow Occlusion Delivers Concentrated Levels of Chemotherapy to Ipsilateral Hilar and Mediastinal Lymph Nodes

BACKGROUND: Although survival is historically low for patients presenting with N2 lung cancer, patients who respond to chemotherapy have up to a 30% chance for long term survival or cure. Selective pulmonary artery perfusion (SPAP) has been examined in several animal studies as a method for delivering chemotherapy in non-small cell lung cancer; however, there is a paucity of data regarding the effect of SPAP on regional lymph nodes. METHODS: Left SPAP was performed using gemcitabine on five swine and compared with standard central venous infusion in controls. Samples were taken from lung, kidney, liver, plasma, and lymph nodes. Tissue was measured for gemcitabine concentration using mass spectroscopy. RESULTS: Left SPAP resulted in significantly higher gemcitabine concentration than standard infusion in hilar and mediastinal lymph nodes while plasma gemcitabine concentration was not significantly different. CONCLUSION: SPAP is a viable technique for concentrating a chemotherapeutic agent in the mediastinal and hilar lymph nodes. This could potentially increase the response to chemotherapy and render more patients to be surgical candidates who present with N2 disease.