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Related Experiment Videos

Multimodality therapy for malignant pleural mesothelioma

D J Sugarbaker1, J P Garcia

  • 1Thoracic Oncology Program, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.

Chest
|October 23, 1997
PubMed
Summary

Trimodality therapy, including extrapleural pneumonectomy and chemoradiotherapy, offers improved survival for select mesothelioma patients. This approach is particularly effective for early-stage epithelial mesothelioma.

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Area of Science:

  • Thoracic oncology
  • Surgical oncology
  • Medical oncology

Background:

  • Mesothelioma survival rates are poor with single or dual treatment modalities.
  • Trimodality therapy (extrapleural pneumonectomy + chemoradiotherapy) was investigated to improve outcomes.
  • Selected patients were treated between 1980 and 1995.

Purpose of the Study:

  • To evaluate the efficacy of trimodality therapy for malignant mesothelioma.
  • To identify prognostic factors influencing survival.
  • To assess treatment-related morbidity and mortality.

Main Methods:

  • 120 patients with mesothelioma underwent extrapleural pneumonectomy followed by chemoradiotherapy.
  • Patient data on response, morbidity, and survival were collected.

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  • A revised staging system was developed and validated.

    • Main Results:

    • Operative mortality was 5%, with 22% major morbidity.
    • Epithelial cell type and node-negative status were positive prognostic indicators.
    • Overall 2- and 5-year survival rates were 45% and 22%, respectively.
    • Stage I patients with epithelial histology and negative nodes had 74% 5-year survival.

    Conclusions:

    • Trimodality therapy is effective for select mesothelioma patients, especially those with early-stage epithelial disease.
    • A revised staging system accurately stratifies survival.
    • Extrapleural pneumonectomy with adjuvant therapy is recommended for Stage I disease.