Induction Chemotherapy, Extrapleural Pneumonectomy, and Postoperative High-Dose Radiotherapy for Locally Advanced Malignant Pleural Mesothelioma: A Phase II Trial

Abstract

Introduction: Extrapleural pneumonectomy (EPP) and adjuvant high-dose radiation therapy (RT) are associated with a median survival of 3 years in early-stage malignant pleural mesothelioma (MPM) but of less than 1 year in locally advanced disease. Although local control after EPP and RT is excellent, most patients die of distant metastases. We designed this clinical trial to test the feasibility of induction chemotherapy followed by EPP and RT in locally advanced MPM with the ultimate aim of improving survival. Methods: Patients with MPM and stage III or IV disease were eligible. Induction therapy was four cycles of gemcitabine and cisplatin. Patients without disease progression by computed tomography underwent EPP followed by adjuvant hemithoracic RT (54 cGy). Results: From January 2002 to January 2004, 21 patients (17 men, four women; median age 60 years) were entered into the study. Histology was epithelioid in 14 patients and mixed or sarcomatoid five patients. Pretreatment disease stage was III in 13 patients and IV in six patients. Nineteen patients received induction chemotherapy. Response to induction therapy was complete in zero patients, partial in five patients, stable disease in six patients, and progression of disease in eight patients. Eight of nine patients undergoing surgical exploration had EPP. The median survival of all patients was 19 months. Patients who had an EPP had a median survival of 33.5 months. Patients with unresectable tumors had a median survival of 9 months (p ϭ 0.01). Conclusion: Induction chemotherapy with gemcitabine and cisplatin followed by EPP and adjuvant RT for locally advanced MPM is feasible and leads to a better median overall survival than that previously reported with EPP and RT alone.

Induction chemotherapy, extrapleural pneumonectomy, and radiotherapy in the treatment of malignant pleural mesothelioma: The Memorial Sloan-Kettering experience

“…We observed a resectability rate in this already advanced stage group of 88% which is better than the quoted resectability rate of 75% for most series. However, the preliminary results of this trial and of our pilot data did demonstrate that induction chemotherapy is feasible [20]. In addition; induction chemotherapy seemed to be part of a process of selecting out patients who would benefit most from a multimodality regimen.…”

Is malignant pleural mesothelioma a surgical disease? A review of 83 consecutive extra-pleural pneumonectomies☆☆☆

“…Obviously, with regards to the high postoperative morbidity reported after EPP (25-63%), there is no rationale in considering EPP in a palliative intent [18][19][20][21][22].…”

Volumetric Modulation Arc Radiotherapy Compared With Static Gantry Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma Tumor: A Feasibility Study

“…Trimodal treatment, including chemotherapy, surgery (extrapleural pneumonectomy), and adjuvant radiotherapy (RT) have been used to improve the disastrous prognosis of MPM (3,4). In particular, postoperative RT has been proposed to reduce the risk of local progression, which developed in 80% of patients who underwent extrapleural pneumonectomy alone (5).…”