Objectives: Stage III non-small cell lung cancer (NSCLC) has a poor prognosis. Reports suggest that five-year survival after current treatment is between 14 to 24 percent. The purpose of this retrospective study was to investigate the morbidity and mortality of patients diagnosed with stage III NSCLC and treated with pneumonectomy at the University of Kentucky Medical Center in Lexington, KY. Methods: We reviewed the medical record and tumor registry follow-up data on 100 consecutive patients who underwent pneumonectomy for lung cancer at the University of Kentucky. Results: We identified thirty-six patients in stage III who underwent pneumonectomy. Ten patients had surgery only, eight patients received adjuvant chemotherapy, and eighteen patients received neoadjuvant therapy. There was one surgical death in this series. Mean follow-up was 2.9 years. One-, three-, and five-year survival was 66%, 38%, and 38%, respectively. Five-year survival for the group with adjuvant therapy was 60%. Conclusion: Most lung cancer patients present with advanced disease and the prognosis remains poor. Our experience indicates resection offers an above average chance of long-term survival when supplemented with neoadjuvant and/or adjuvant therapy.

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Purpose: HEATT® is veno-venous perfusion-induced systemic hyperthermia with a heart-lung pump, dialysis, blood sorbent, and CO2/pH control with flow at 20% of cardiac output to homogeneously increase core temperature to 42°C for 120 min while normalizing fluid and electrolyte changes. Two Phase 1 FDA trials (advanced lung, ovarian cancer), demonstrated safety and efficacy. We are reporting progress on an open label, non-randomized, early feasibility, single dose of HEATT® to treat select cancer patients with persistent or recurrent unresectable cancers unresponsive to chemo-, immuno-, and/or curative therapy. Method: Informed consent was obtained. Exclusion criteria: recent brain surgery, metastasis or stroke; organ failure; sepsis; or active bleeding. HEATT® uses 13-17 Fr Femoral-Jugular cannulas placed by image guidance in a veno-venous circuit. All individual components are FDA approved. Upon general anesthesia and systemic anticoagulation, Interventional Radiology placed a triple lumen central line, arterial line, and IVC/SVC venous cannula at L2 for drainage and at SVC/RA junction for infusion of heated blood for a targeted 20% cardiac output flow to increase core temperature to 42°C for 120 min. Patients are cooled to 38°C, then recovered. Results: All patients met criteria and were hospice eligible with a mean predicted survival of 90 days. Primary cancers included ovarian (5), colon (2), breast (2), lung (1), pancreatic (1), cholangiocarcinoma (1), and liposarcoma (1). All achieved 42°C core temperature for 120 min with stable hemodynamics, heat transfer, and circuit dynamics. No complications were identified specific to HEATT®. Length of stay was 2-4 days including treatment, 12/13 survived to 30-day all-cause mortality, while 1/13 died of pulmonary hemorrhage from multiple metastasis. Eight of 13 exceeded expected median survival, 6/13 exceeded 180 day predicted maximum end-of-life. Four are alive and active at 500, 386, 360, and 288 days (Max 530). Twelve of 13 recovered to receive additional therapies. Frailty, age >80, and immobility negatively impact recovery. HEATT® does not predictably relieve tumor obstruction. Summary: We recommend HEATT® for treatment of advanced cancer patients unresponsive to conventional treatments.