Induction chemotherapy, extrapleural pneumonectomy, and postoperative high-dose radiotherapy for locally advanced malignant pleural mesothelioma: A phase II trial Journal Article


Authors: Flores, R. M.; Krug, L. M.; Rosenzweig, K. E.; Venkatraman, E.; Vincent, A.; Heelan, R.; Akhurst, T.; Rusch, V. W.
Article Title: Induction chemotherapy, extrapleural pneumonectomy, and postoperative high-dose radiotherapy for locally advanced malignant pleural mesothelioma: A phase II trial
Abstract: INTRODUCTION: Extrapleural pneumonectomy (EPP) and adjuvant high-dose radiation therapy (RT) are associated with a median survival of 3 years in early-stage malignant pleural mesothelioma (MPM) but of less than 1 year in locally advanced disease. Although local control after EPP and RT is excellent, most patients die of distant metastases. We designed this clinical trial to test the feasibility of induction chemotherapy followed by EPP and RT in locally advanced MPM with the ultimate aim of improving survival. METHODS: Patients with MPM and stage III or IV disease were eligible. Induction therapy was four cycles of gemcitabine and cisplatin. Patients without disease progression by computed tomography underwent EPP followed by adjuvant hemithoracic RT (54 cGy). RESULTS: From January 2002 to January 2004, 21 patients (17 men, four women; median age 60 years) were entered into the study. Histology was epithelioid in 14 patients and mixed or sarcomatoid five patients. Pretreatment disease stage was III in 13 patients and IV in six patients. Nineteen patients received induction chemotherapy. Response to induction therapy was complete in zero patients, partial in five patients, stable disease in six patients, and progression of disease in eight patients. Eight of nine patients undergoing surgical exploration had EPP. The median survival of all patients was 19 months. Patients who had an EPP had a median survival of 33.5 months. Patients with unresectable tumors had a median survival of 9 months (p = 0.01). CONCLUSION: Induction chemotherapy with gemcitabine and cisplatin followed by EPP and adjuvant RT for locally advanced MPM is feasible and leads to a better median overall survival than that previously reported with EPP and RT alone. © 2006International Association for the Study of Lung Cancer.
Keywords: adult; cancer chemotherapy; cancer survival; clinical article; controlled study; treatment response; aged; middle aged; clinical trial; fatigue; mortality; cisplatin; advanced cancer; cancer growth; multimodality cancer therapy; unspecified side effect; gemcitabine; cancer adjuvant therapy; cancer radiotherapy; combined modality therapy; cancer staging; antineoplastic agent; neoplasm staging; prospective study; prospective studies; computer assisted tomography; infection; multiple cycle treatment; pain; phase 2 clinical trial; anemia; bleeding; esophagitis; lung resection; nausea; antineoplastic combined chemotherapy protocols; pneumonectomy; dehydration; deep vein thrombosis; herpes zoster; pathology; histology; hypotension; odynophagia; feasibility study; drug derivative; pleura mesothelioma; mesothelioma; pleura tumor; deoxycytidine; wound infection; extrapleural pneumonectomy; empyema; heart atrium fibrillation; pleural neoplasms; induction chemotherapy
Journal Title: Journal of Thoracic Oncology
Volume: 1
Issue: 4
ISSN: 1556-0864
Publisher: Elsevier Inc.  
Date Published: 2006-05-01
Start Page: 289
End Page: 295
Language: English
DOI: 10.1097/01243894-200605000-00004
PUBMED: 17409872
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 68" - "Export Date: 4 June 2012" - "Source: Scopus"
Altmetric
Citation Impact
MSK Authors
  1. Venkatraman Ennapadam Seshan
    370 Seshan
  2. Valerie W Rusch
    825 Rusch
  3. Lee M Krug
    221 Krug
  4. Raja Flores
    108 Flores
  5. Timothy J Akhurst
    139 Akhurst
  6. Alain M Vincent
    19 Vincent
  7. Robert T Heelan
    140 Heelan