Complete response and long-term survival in malignant pleural mesothelioma: case report

Malignant pleural mesothelioma is a rare tumour. A three-modal strategy, comprising of surgery, radiotherapy and chemotherapy has been shown to be essential for appropriate management. Current literature evidences the importance of radiation therapy in the adjuvant setting for local control of the disease, as part of a multidisciplinary treatment, with increment of progression-free survival rate, but also of disease-free survival.

At the beginning of 2007, a 26-year-old Peruvian woman was admitted to the hospital referring breathlessness and other non-specific symptoms such as fever and weight loss. After the diagnosis of pleural mesothelioma by thoracoscopic talc insufflation, combined with pleural biopsy, and total body computed tomographic scan, the patient underwent two cycles of neoadjuvant chemotherapy with pemetrexed (500 mg/m(2)) and cisplatin (75 mg/m(2)), followed by an extra-pleural pneumonectomy. After 6 months, the patient was treated with three-dimensional external beam radiation therapy to the left hemithorax. Computed tomographic scans, performed after the ending of the radiotherapy, integrated with positron-emission tomography, were all negative for neoplastic pathology. The patient remains in good health and free from recurrence at four years.

This clinical case shows a disease-free survival interval of 4 years for malignant pleural mesothelioma. A good staging system and a combined treatment, involving surgery, neoadjuvant chemotherapy and adjuvant radiation therapy, represent a useful strategy not only to contain local disease progression, but even to increase disease-free survival in pleural mesothelioma.