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Aggressive multimodality therapy for malignant pleural mesothelioma

T W Rice1, D J Adelstein, T J Kirby

  • 1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44195.

The Annals of Thoracic Surgery
|July 1, 1994
PubMed
Summary
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Aggressive multimodality therapy for stage I malignant pleural mesothelioma showed effective palliation and occasional long-term survival. Despite significant toxicity, this approach offers benefits for select patients with this rare cancer.

Area of Science:

  • Thoracic Oncology
  • Surgical Oncology
  • Medical Oncology

Background:

  • Malignant pleural mesothelioma is a rare, aggressive cancer.
  • Clinical stage I offers a potential window for curative-intent treatment.

Purpose of the Study:

  • To evaluate the efficacy and safety of aggressive multimodality therapy for clinical stage I malignant pleural mesothelioma.
  • To assess patient outcomes including survival, disease-free survival, and palliation.

Main Methods:

  • Nineteen patients with stage I malignant pleural mesothelioma received pleurectomy/decortication or pleuropneumonectomy.
  • Intrapleural chemotherapy (cisplatin, mitomycin C) was administered immediately post-surgery.
  • Adjuvant systemic cisplatin-based chemotherapy was given 4–8 weeks post-operation.

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Main Results:

  • Median overall survival was 13 months; median disease-free survival was 11 months.
  • Three-year overall and disease-free survival rates were 17% and 22%, respectively.
  • Epithelial histology correlated with significantly better survival outcomes (p < 0.05).

Conclusions:

  • Aggressive multimodality therapy can achieve effective palliation and long-term disease control in select stage I malignant pleural mesothelioma patients.
  • The treatment regimen, particularly systemic chemotherapy, exhibited significant toxicity, including one chemotherapy-related death.
  • Despite toxicity, the approach offers a chance for long-term survival in carefully selected individuals.