Trimodality Therapy With Induction Chemotherapy Followed by Extrapleural Pneumonectomy and Adjuvant High-Dose Hemithoracic Radiation for Malignant Pleural Mesothelioma

We examined the results of trimodality therapy with cisplatin-based chemotherapy followed by extrapleural pneumonectomy and adjuvant high-dose hemithoracic radiation therapy for Malignant pleural mesothelioma

Marc de Perrot

2009

Scholarcy highlights

  • Section: Malignant pleural mesothelioma is an aggressive malignancy associated with a median survival of approximately 9 months after diagnosis.1 The tumor is usually related to asbestos exposure and affects at least 2,000 people in the United States yearly.2,3 The incidence is anticipated to peak between 2010 and 2020 because of the lag time between asbestos exposure and the development of the malignancy.3MPM presents unique challenges with regard to diagnosis, staging, and treatment
  • After completion of the protocol, the 5-year disease-free survival was 53% for patients with N0 disease, reaching 75% in patients with ypT1-2N0 and 45% in patients with ypT3-4N0. This large, single-center experience with induction chemotherapy followed by Extrapleural pneumonectomy and adjuvant high-dose hemithoracic radiation for MPM shows that half of the patients are able to complete this protocol
  • N2 disease remains a major factor impacting on survival, despite completion of the entire trimodality regimen
  • Seven patients were excluded from the trimodality approach: three patients refused chemotherapy, two patients had a diagnosis of sarcomatoid MPM and underwent EPP without induction chemotherapy, one patient had already received cisplatin-based chemotherapy and was not eligible for further chemotherapy, and one patient had a history of radiation to the upper abdomen and was not eligible for adjuvant hemithoracic radiation
  • Cisplatin plus vinorelbine was used in 26 patients, cisplatin plus pemetrexed was used in 24 patients, cisplatin plus raltitrexed was used in six patients, and cisplatin plus gemcitabine was used in four patients
  • Cisplatin plus vinorelbine was well tolerated for induction chemotherapy in patients with MPM, the combination was changed to cisplatin plus pemetrexed after the results of a large, phase III, randomized trial demonstrated a response rate of 41% associated with prolonged survival in patients treated with cisplatin plus pemetrexed when compared with cisplatin alone

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