Journal article
Survival after trimodality therapy for malignant pleural mesothelioma: Radical Pleurectomy, chemotherapy with Cisplatin/Pemetrexed and radiotherapy
Lung cancer (Amsterdam, Netherlands), Vol.71(1), pp.75-81
2011
DOI: 10.1016/j.lungcan.2009.08.019
PMID: 19765853
Abstract
The role of surgery in the management of malignant pleural mesothelioma (MPM) is controversial and there are no established guidelines. We describe the feasibility and long-term outcomes associated with Radical Pleurectomy (RP) as surgical therapy modality in a standardized trimodality therapy concept of MPM.
From November 2002 to October 2007, 35 out of 102 consecutive patients with MPM were enrolled in our prospective database. They underwent trimodality therapy, including RP followed by 4 cycles of chemotherapy with Cisplatin (75
mg/m
2)/Pemetrexed (500
mg/m
2) and radiotherapy 4–6 weeks after operation.
Median age was 65 years. Nineteen patients were in advanced stages III and IV (54.3%). Tumor histology was epithelial in 27 patients (77.1%). Macroscopic complete resection could be achieved in 18 patients (51.4%). Surgical morbidity/mortality and trimodality treatment-related mortality were 20.0%, 2.9% and 5.8%, respectively. Thirty-three patients completed the trimodality therapy. Median follow-up was 21.7 months. Overall median survival was 30.0 months. One-, 2-, and 3-year-survival were 69%, 50% and 31%, respectively. Advanced stages III/IV (
p
=
0.06), macroscopic incomplete resections (
p
=
0.001), non-epithelial histology (
p
=
0.55) and nodal metastases (
p
=
0.19) were associated with poorer survival.
The trimodality therapy concept with RP demonstrates promising results in terms of long-term survival, morbidity and mortality. We propose that a surgical philosophy of limiting the procedure related morbidity while achieving comparable cytoreductive results allows patients to maintain physiological reserve to be eligible for multimodality treatment options in the long-term. The observed and theoretical benefits of this trimodality treatment approach warrant confirmation in larger RCT.
Details
- Title: Subtitle
- Survival after trimodality therapy for malignant pleural mesothelioma: Radical Pleurectomy, chemotherapy with Cisplatin/Pemetrexed and radiotherapy
- Creators
- Servet Bölükbas - Department of Thoracic Surgery, Dr.-Horst-Schmidt-Klinik, Ludwig-Erhard-Strasse 100, 65199 Wiesbaden, GermanyChristian Manegold - University Medical Center Mannheim, Heidelberg University, Mannheim, GermanyMichael Eberlein - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USAThomas Bergmann - Department of Thoracic Surgery, Dr.-Horst-Schmidt-Klinik, Ludwig-Erhard-Strasse 100, 65199 Wiesbaden, GermanyAnnette Fisseler-Eckhoff - Institutes for Pathology and Cytology, Dr.-Horst-Schmidt-Klinik, Wiesbaden, GermanyJoachim Schirren - Department of Thoracic Surgery, Dr.-Horst-Schmidt-Klinik, Ludwig-Erhard-Strasse 100, 65199 Wiesbaden, Germany
- Resource Type
- Journal article
- Publication Details
- Lung cancer (Amsterdam, Netherlands), Vol.71(1), pp.75-81
- Publisher
- Elsevier Ireland Ltd
- DOI
- 10.1016/j.lungcan.2009.08.019
- PMID
- 19765853
- ISSN
- 0169-5002
- eISSN
- 1872-8332
- Language
- English
- Date published
- 2011
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984094617602771
Metrics
12 Record Views