Survival after trimodality therapy for malignant pleural mesothelioma: Radical Pleurectomy, chemotherapy with Cisplatin/Pemetrexed and radiotherapy
Survival after trimodality therapy for malignant pleural mesothelioma: Radical Pleurectomy, chemotherapy with Cisplatin/Pemetrexed and radiotherapy
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DOI：
10.1016/j.lungcan.2009.08.019
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发表时间：
2011-01-01
期刊：
影响因子：
5.3
通讯作者：
Schirren, Joachim
中科院分区：
文献类型：
--
作者：
Boeluekbas, Servet;Manegold, Christian;Schirren, Joachim
前言：手术在恶性胸膜间皮瘤（MPM）治疗中的作用是有争议的，目前尚无既定的指南。我们描述的可行性和长期的结果与根治性胸膜切除术（RP）的手术治疗方式在标准化的三模式治疗的概念MPM.Methods：从2002年11月至2007年10月，35的102例连续的MPM患者被纳入我们的前瞻性数据库。所有患者均接受三联治疗，包括RP，顺铂（75 mg/m2）/培美曲塞（500 mg/m2）化疗4个周期，术后4-6周放疗。19例患者处于晚期III期和IV期（54.3%）。27例患者（77.1%）的肿瘤组织学为上皮性。18例（51.4%）患者可实现肉眼完全切除。手术发病率/死亡率和三联治疗相关死亡率分别为20.0%、2.9%和5.8%。33例患者完成了三联疗法。中位随访时间为21.7个月。总体中位生存期为30.0个月。1、2、3年生存率分别为69%、50%、31%。晚期III/IV期（p = 0.06），宏观不完全切除（p = 0.001），非上皮组织学（p = 0.55）和淋巴结转移（p = 0.19）与较差的survival.Conclusions：与RP的三联疗法的概念表现出良好的长期生存，发病率和死亡率方面的结果。我们建议，限制手术相关的发病率，同时实现可比的细胞减灭的结果，使患者能够保持生理储备，有资格在长期的多模态治疗选择的手术理念。这种三联治疗方法的观察到的和理论上的益处需要在更大的RCT中得到证实。(C)2009爱思唯尔爱尔兰有限公司保留所有权利。
Introduction: The role of surgery in the management of malignant pleural mesothelioma (MPM) is controversial and there are no established guidelines. We describe the feasibility and long-term outcomes associated with Radical Pleurectomy (RP) as surgical therapy modality in a standardized trimodality therapy concept of MPM.Methods: From November 2002 to October 2007, 35 out of 102 consecutive patients with MPM were enrolled in our prospective database. They underwent trimodality therapy, including RP followed by 4 cycles of chemotherapy with Cisplatin (75 mg/m(2))/Pemetrexed (500 mg/m(2)) and radiotherapy 4-6 weeks after operation.Results: Median age was 65 years. Nineteen patients were in advanced stages III and IV (54.3%). Tumor histology was epithelial in 27 patients (77.1%). Macroscopic complete resection could be achieved in 18 patients (51.4%). Surgical morbidity/mortality and trimodality treatment-related mortality were 20.0%, 2.9% and 5.8%, respectively. Thirty-three patients completed the trimodality therapy. Median follow-up was 21.7 months. Overall median survival was 30.0 months. One-, 2-, and 3-year-survival were 69%, 50% and 31%, respectively. Advanced stages III/IV (p=0.06), macroscopic incomplete resections (p=0.001), non-epithelial histology (p=0.55) and nodal metastases (p=0.19) were associated with poorer survival.Conclusions: The trimodality therapy concept with RP demonstrates promising results in terms of long-term survival, morbidity and mortality. We propose that a surgical philosophy of limiting the procedure related morbidity while achieving comparable cytoreductive results allows patients to maintain physiological reserve to be eligible for multimodality treatment options in the long-term. The observed and theoretical benefits of this trimodality treatment approach warrant confirmation in larger RCT. (C) 2009 Elsevier Ireland Ltd. All rights reserved.