By Jenny Powers
LUGANO, Switzerland -- May 11, 2009 -- Pleurectomy/decortication performed prior to chemotherapy is effective as the surgical intervention in multimodality therapy for patients with malignant pleural mesothelioma (MPM), according to a study presented at the European Multidisciplinary Conference in Thoracic Oncology (EMCTO) 2009.
Multimodality therapy is accepted as the best approach to treating MPM, and Servet Bölükbas, MD, Department of Thoracic Surgery, Dr. Horst Schmidt Kliniken, Wiesbaden, Germany, and his team designed this study to explore the results of using pleurectomy/decortication, rather than pneumonectomy, as the surgical stage in a trimodal treatment strategy for MPM. The findings were reported May 3.
This prospective study enrolled 35 patients with histological diagnosis of MPM over a 5-year period (November 2002 to October 2007). Ten patients (28.6%) had stage I disease, 6 (17.1%) had stage II, 17 (48.6%) had stage III, and 2 (5.7%) of the patients had stage IV disease. Twenty-five (71%) patients were diagnosed with epithelial histology, and ipsilateral nodal metastases were found in 5 (14.3%) patients.
Patients received multimodality therapy with pleurectomy/decortication followed by 4 cycles of chemotherapy with cisplatin (75 mg/m2) and pemetrexed (500 mg/m2) and radiation therapy to the chest wall and mediastinum between 4 to 6 weeks after surgery. The surgical morbidity rate was 20.0% and the mortality rate was 2.9%; one death was due to chemotherapy toxicity. The trimodality therapy was completed by 33 out of 35 patients.
The overall median survival was 33.2 months with a 1-year survival rate of 75%. The 2- and 3-year-survival rates were 61% and 43%, respectively.
Eight (24.2%) of 33 patients experienced local disease recurrence, and 7 (21.2%) developed distant metastases. Local and distant recurrence occurred in 1 (3%) patient.
The authors concluded that multimodality therapy using pleurectomy/decortication as the surgical element in a multimodal chemoradiation therapy regimen demonstrates good morbidity, mortality, and survival results, and that this treatment for MPM warrants further testing in controlled multicentre studies.
EMCTO 2009 was co-organised by the European Society for Medical Oncology (ESMO), the European Society for Therapeutic Radiology and Oncology (ESTRO), the European Society of Thoracic Surgeons (ESTS), and the European Respiratory Society (ERS).
[Presentation title: Multimodality Therapy for Malignant Pleural Mesothelioma: Pleurectomy/Decortication Followed by Chemotherapy With Cisplatin/Pemetrexed and Radiotherapy. Abstract 151PD]
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