Induction chemotherapy, extrapleural pneumonectomy (EPP) and adjuvant hemi-thoracic radiation in malignant pleural mesothelioma (MPM): Feasibility and results

Federico Rea, Giuseppe Marulli, Luigi Bortolotti, Cristiano Breda, Adolfo Gino Favaretto, Lucio Loreggian, Francesco Sartori

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Trimodality therapy seems to be the best treatment for malignant pleural mesothelioma (MPM). A large experience served to evaluate the efficacy of surgery followed by adjuvant chemo-radiotherapy. Trimodality therapy results have led us to test induction chemotherapy followed by EPP and adjuvant radiotherapy in stages I-III of MPM. The aim of our study was to evaluate the feasibility of this protocol and to estimate survival. Methods: From 2000 to 2003, 21 patients with MPM (14 males and 7 females, median age 59 years) were enrolled in the prospective study. Induction chemotherapy consisted of Carboplatin (AUC 5 mg/mL/min on Day 1) and Gemcitabine (1000 mg/m2 on Days 1, 8, 15) for three to four cycles. EPP was performed 3-5 weeks after induction therapy, while post-operative RT was given 4-6 weeks after operation. Results: Ten patients received three cycles of chemotherapy, 10 patients received four cycles and 1 patient had two cycles. Grades 3-4 haematological toxicity occurred in eight (38.1%) patients. Chemotherapy response rate was: complete 0%, partial 33.3% and stable disease 66.7%. Seventeen (80.9%) out of 21 patients underwent EPP with no intra or post-operative mortality with an overall major and minor morbidity rate at 52.4%. Median survival was 25.5 months, with an overall 1, 3 and 5-year survival rate of 71, 33 and 19%, respectively. Conclusions: In MPM, the combined modality approach using the Carboplatin/Gemcitabine combination as induction chemotherapy is feasible, with good results in terms of survival and morbidity. Our results are similar to those of other studies using a heavier modality treatment.

Original languageEnglish
Pages (from-to)89-95
Number of pages7
JournalLung Cancer
Volume57
Issue number1
DOIs
Publication statusPublished - Jul 2007

Keywords

  • Induction chemotherapy
  • Malignant pleural mesothelioma
  • Radiation therapy
  • Surgery

ASJC Scopus subject areas

  • Oncology

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