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

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 5mg/mL/min on Day 1) and Gemcitabine (1000mg/m(2) 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.

• Authors: Federico Rea, Giuseppe Marulli, Luigi Bortolotti, Cristiano Breda, Adolfo Gino Favaretto, Lucio Loreggian, Francesco Sartori
• Journal: Lung cancer (Amsterdam, Netherlands) (Lung Cancer) Vol. 57 Issue 1 Pg. 89-95 (Jul 2007) ISSN: 0169-5002 [Print] Ireland
• PMID: 17403553 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Antimetabolites, Antineoplastic
• Antineoplastic Agents
• Deoxycytidine
• Carboplatin
• Gemcitabine

Topics

• Adult
• Aged
• Anemia (chemically induced)
• Antimetabolites, Antineoplastic (administration & dosage, toxicity)
• Antineoplastic Agents (administration & dosage, toxicity)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, toxicity)
• Carboplatin (administration & dosage, toxicity)
• Combined Modality Therapy
• Deoxycytidine (administration & dosage, analogs & derivatives, toxicity)
• Drug Administration Schedule
• Feasibility Studies
• Female
• Follow-Up Studies
• Humans
• Leukopenia (chemically induced)
• Male
• Mesothelioma (drug therapy, pathology, radiotherapy, surgery)
• Middle Aged
• Neoplasm Recurrence, Local (pathology)
• Neoplasm Staging
• Neutropenia (chemically induced)
• Pleural Neoplasms (drug therapy, pathology, radiotherapy, surgery)
• Pneumonectomy (statistics & numerical data)
• Radiation Dosage
• Radiotherapy, Adjuvant
• Survival Analysis
• Thrombocytopenia (chemically induced)
• Time Factors
• Gemcitabine