Surgery followed by intracavitary plus systemic chemotherapy in malignant pleural mesothelioma

Aims and background: Malignant mesothelioma is associated with a median survival of 4 to 12 months. Data from the literature indicate that single modality treatment (surgery or intrapleural and/or systemic chemotherapy) does not significantly affect survival. Methods: We therefore evaluated a combined approach consisting of surgery (pleurectomy + diaphragmatic or pericardial resection), intrapleural chemotherapy with cisplatin (100 mg/m²) and cytarabine (1,000 mg/m²) tor 4 h immediately after pleurectomy, and systemic chemotherapy consisting of epirubicin (60 mg/m²) and mitomycin-C (10 mg/m²) day 1 every 4 weeks for 4 cycles. Results: Twenty patients were enrolled in the study and were evaluable. Thirteen cases had residual gross disease after pleurectomy and 7 patients only minimal disease. Median time to disease progression was 7.4 months, and median survival was 11.5 months (range, 2-25+). No treatment-related death have been observed. Side effects after intracavitary chemotherapy included renal toxicity, anaemia and pain. Myelosuppression and alopecia were recorded during systemic chemotherapy. Conclusions: The results of the study indicate that the schedule is feasible, with encouraging results in terms of survival for patients with minimal residual disease after surgery.