Survival and relapse pattern after trimodality therapy for malignant pleural mesothelioma

Multimodality therapy has been applied to resectable malignant pleural mesothelioma, but the tolerability of the treatment and relapse pattern in detail remain unknown. We reviewed our experience of trimodality therapy as a single-institution study in Japan.

A total of 16 patients with resectable malignant pleural mesothelioma were intended to treat with extra-pleural pneumonectomy followed by platinum-based chemotherapy and external beam radiation therapy. The histology of the tumors was epithelioid in 10, sarcomatoid in 4, and biphasic in 2. International Mesothelioma Interest Group staging was stage II in 1, stage III in 11, and stage IV in 4. The tolerability to the combined treatment, the survival, and the relapse pattern were examined.

All patients underwent a macroscopic complete resection. In all, 14 patients received chemotherapy, and subsequently 13 underwent radiotherapy, indicating a tolerability of 81%. The overall median survival was 28.1 months; and the 2-year and 5-year survival rates were 53.3% and 26.7%, respectively. In patients with stage III or lower disease, the median survival was 37.9 months. Recurrence was seen in eight patients; the first relapse site was local in seven and distant in two. The local recurrences occurred within 24 months, mostly around 12 months, after the extrapleural pneumonectomy, whereas the distant metastases occurred later.

Trimodality therapy showed a survival benefit in patients with stage III or lower malignant pleural mesothelioma. Most of the recurrences were local. Therefore, better local control is required to improve the prognosis of the disease.