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Original article

Vol. 142 No. 4344 (2012)

Long term survival after trimodal therapy in malignant pleural mesothelioma

  • René Fahrner
  • Adrian Ochsenbein
  • Ralph Alexander Schmid
  • Giovanni Luca Carboni
DOI
https://doi.org/10.4414/smw.2012.13686
Cite this as:
Swiss Med Wkly. 2012;142:w13686
Published
21.10.2012

Summary

PRINCIPLES: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

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