Abstract
Trimodal therapy results in long term survival in a small fraction of patients with malignant pleural mesothelioma, particularly in patients having epithelial histology, R0-resection and no nodal involvement. This study analyses the outcome after trimodal therapy including extrapleural pneumonectomy. From 2000 to 2005 41 patients with histologically verified malignant pleural mesothelioma were included. Diagnosis and nodal status were confirmed by surgery. 21 patients (51%) underwent trimodal therapy with 655 days (63-2,567 days) of median follow-up. Postoperative complications, mortality, long term survival and recurrence rates were analysed retrospectively. Neoadjuvant chemotherapy consisted of a combination of platinum based agents (n = 19) with gemcitabine (n = 15) or pemetrexed (n = 4). Extrapleural pneumonectomy was the standard procedure for surgery. 13 patients (62%) had postoperative complications. 16 patients (76%) received postoperative adjuvant radiotherapy. There was a 30-day mortality of 4.8% in the trimodal group. Survival rates in the trimodal group were 71% after one, 28% after two and 10% after five years. There were no significant differences regarding age, tumour stage, cell type or lymph node involvement. Tumour recurrence occurred after one and two years in 44% and in 83% respectively. The majority of patients considered for surgical resection of malignant pleural mesothelioma have regionally advanced disease. In those receiving trimodal therapy long term survival is achieved only in a minority of patients. In view of the time consuming and intensive treatment it should be offered only in carefully selected patients as new surgical approaches such as pleurectomy/decortication have shown high efficacy rates regarding patients' survival.
Highlights
Malignant pleural mesothelioma (MPM) arises in the pleural space and the clinical picture can be variable
This study analyses the outcome after trimodal therapy including extrapleural pneumonectomy
Neoadjuvant chemotherapy consisted of a combination of platinum based agents (n = 19) with gemcitabine (n = 15) or pemetrexed (n = 4)
Summary
Malignant pleural mesothelioma (MPM) arises in the pleural space and the clinical picture can be variable. On the basis of the latest reports, decortication/pleurectomy has become more important in the treatment of malignant pleural mesothelioma as survival rates seem to be better than after EPP [16, 17]. Complications after extrapleural pneumonectomy are frequent and frequently surgically related, for example bronchopleural fistula, diaphragmatic patch dehiscence, ARDS, cardiac arrhythmias, constrictive patch reconstruction of the pericardium, infection and bleeding [8, 18] These can be successfully avoided and managed by proper selection of patients, meticulous technique and adequate pre- and postoperative management [13, 19, 20].
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