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Ann Thorac Surg 2009;88:870-876. doi:10.1016/j.athoracsur.2009.05.036
© 2009 The Society of Thoracic Surgeons
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Gordon Buduhan
Ralph Aye
Brian Louie
Eric Vallières
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Original Articles: General Thoracic

Trimodality Therapy for Malignant Pleural Mesothelioma

Gordon Buduhan, MD, FRCSC, Shekhar Menon, MD, Ralph Aye, MD, Brian Louie, MD, FRCSC, Vivek Mehta, MD, Eric Vallières, MD, FRCSC*

Swedish Cancer Institute, Seattle, Washington

Accepted for publication May 13, 2009.

* Address correspondence to Dr Vallières, Swedish Cancer Institute, 850-1101 Madison, Seattle, WA (Email: eric.vallieres{at}swedish.org).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: Malignant pleural mesothelioma is a fatal disease. The optimal modality and sequence of therapy are controversial. We analyzed the outcomes of a cohort of mesothelioma patients treated with induction chemotherapy, followed by extrapleural pneumonectomy (EPP) and adjuvant radiation.

Methods: The study comprised a retrospective cohort of 46 patients treated with induction chemotherapy, followed by EPP, during a 10-year period. Of these, 24 completed adjuvant external beam radiotherapy (EBRT), and 14 had intensity-modulated radiotherapy (IMRT).

Results: Mean follow-up was 20.6 months (range, 0.5 to 75 months). Operative mortality after EPP was 4.3% (n = 2). Pathologic stage was p0, 4.3%; pII, 23.9%; pIII, 56.5%; and pIV, 15.2%. Median overall survival was 24 months. On univariate analysis and Cox proportional hazards model, only nodal metastases (hazard ratio, 3.7; 95% confidence interval, 1.6 to 8.7; p = 0.002) was a significant predictor of survival. First site of recurrence was local in 12, the contralateral chest in 5, abdominal in 8, and distant in 5. The incidence of local recurrence was 14.3% with IMRT vs 41.7% with EBRT (p = 0.03). The time to local recurrence with the use of IMRT was 12 months vs 7 for EBRT (p = 0.19).

Conclusions: Induction chemotherapy, followed by EPP and adjuvant radiotherapy for selected patients with mesothelioma, is safe, with acceptable operative mortality. Adjuvant IMRT may be more effective in terms of local control than EBRT.






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Copyright © 2009 by The Society of Thoracic Surgeons.