Lntra-Arterial Perfusion of Diffuse Pleural Mesothelioma – an Alternative Management for Inoperable Cases

Abstract

Background: The prognosis of diffuse pleural mesothelioma remains unfavourable, with or without therapy. And no curative approach has been established to date. At present, tumour decortication involving pleurectomy is the therapy of choice for younger patients at a favourable stage of tumour formation and histology. The role of oncological therapy for patients with inoperable progression of the disease is unsatisfactory and still subject to controversial discussion. Patient and Method: We report on a management concept combining radiation and direct intra-arterial perfusion of cisplatin and mitoxantrone for primary inoperable pleural mesothelioma showing diffuse growth at an advanced stage and on the clinical progression. In the course of treatment the truncus costobronchialis and the 5th ot 12th intercostal artery of the left hemithorax were selected with various frequencies and used for chemotherapy. Result: Management consisted of 11 intra-arterial perfusions of the left hemithorax using mitoxantrone and cisplatin, accompanied by radiation with a total focal dosage of 46 Gy (Linac). Due to this therapy regime the patient survived for 28 months, enjoying a good quality of life. Conclusion: The case reported suggests that such a therapy approach combining intra-arterial, direct perfusion with radiotherapy for the management of pronounced and irreversible manifestations of pleural mesothelioma (stage IV) is effective even from a palliative point of view. Thus we consider it highly recommendable as compared to alternative therapies, regarding the resultant quality of life and life expectancy.