Induction chemotherapy, extrapleural pneumonectomy, and radiotherapy in the treatment of malignant pleural mesothelioma: The Memorial Sloan-Kettering experience Journal Article
| Author: | Flores, R. M. |
| Article Title: | Induction chemotherapy, extrapleural pneumonectomy, and radiotherapy in the treatment of malignant pleural mesothelioma: The Memorial Sloan-Kettering experience |
| Abstract: | Approximately 25% of patients with malignant pleural mesothelioma (MPM) prove unresectable at surgery and the median survival of stage III MPM is <12 months even after complete resection by extrapleural pneumonectomy. From 1939-2004, a series of sequential clinical trials has been performed at our institution. The surgical procedure has been modified and improved upon, and adjuvant hemithoracic radiation (RT) standardized. The evolution of our current standard of care for MPM is discussed. Improving chemotherapy for MPM led us to test induction chemotherapy followed by EPP and adjuvant RT for locally advanced MPM to assess feasibility. Patients with T3-4 or N2 MPM by CT and PET scans were enrolled on a phase II study. Induction therapy was: gemcitabine (1250 mg/m2 days 1, 8) and cisplatin (75 mg/m2 day 8) × 2-4 cycles. Patients underwent EPP 3-5 weeks after induction therapy, then 54 Gy RT 4-6 weeks postop. At surgery, 8/9 had complete resection by EPP with no postoperative deaths. All received planned adjuvant RT. This combined modality approach is feasible for locally advanced MPM, and initial analysis suggests improved resectability. This experience supports additional studies of induction and multimodality therapy, especially with regimens such as cisplatin and pemetrexed which may be better tolerated and more effective. © 2005 Elsevier Ireland Ltd. All rights reserved. |
| Keywords: | cancer survival; cancer surgery; clinical trial; cancer localization; cisplatin; doxorubicin; advanced cancer; drug efficacy; drug safety; multimodality cancer therapy; side effect; treatment planning; gemcitabine; cancer adjuvant therapy; cancer radiotherapy; combined modality therapy; neoadjuvant therapy; radiotherapy, adjuvant; cancer staging; positron emission tomography; recurrent cancer; antineoplastic agent; neoplasm staging; metastasis; quality of life; computer assisted tomography; lung resection; antineoplastic combined chemotherapy protocols; pneumonectomy; radiotherapy; evolution; cyclophosphamide; postoperative complication; standard; survival time; iodine 125; guanine; experience; gene therapy; pleura mesothelioma; mesothelioma; brachytherapy; surgery; surgical mortality; mitomycin; drug dose regimen; deoxycytidine; glutamates; photodynamic therapy; extrapleural pneumonectomy; pemetrexed; drug tolerance; pleural neoplasms; iridium 192; induction chemotherapy; peroperative complication; beam therapy; phosphorus 32 |
| Journal Title: | Lung Cancer |
| Volume: | 49 |
| Issue: | Suppl. 1 |
| ISSN: | 0169-5002 |
| Publisher: | Elsevier Ireland Ltd. |
| Date Published: | 2005-07-01 |
| Start Page: | S71 |
| End Page: | S74 |
| Language: | English |
| DOI: | 10.1016/j.lungcan.2005.03.015 |
| PUBMED: | 15950805 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 25" - "Export Date: 24 October 2012" - "CODEN: LUCAE" - "Source: Scopus" |
