Author of

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  P2.14 - Poster Session 2 - Mesothelioma (ID 196)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Mesothelioma
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11827

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    P2.14-001 - Trimodality treatment of malignant pleural Mesothelioma (MPM). A review of 53 consecutive patients with malignant pleural Mesothelioma, period 10-years January 2002- December 2012. (ID 840)

    09:30 - 09:30  |  Author(s): F. Gradica
    • Abstract

    Background
    Malignant pleural mesothelioma (MPM) is an aggressive neoplasm arising from the surface serosal cells of the pleural cavity. It is a highly lethal disease with a poor prognosis. The incidence of MPM has been predicted to increase rapidly in certain countries until approximately 2020 .Different staging systems for MPM exist . Although mainly related to surgical data, the TNM (tumour, nodes, metastasis)-based classification proposed by the International Mesothelioma Interest Group is the most widely used . MPM has long been surrounded by therapeutic nihilism, as chemotherapy, radiotherapy and surgery have not been proven to be effective as a single treatment modality. The role of surgery in providing maximal debulking is controversial and has not yet been determined. A major breakthrough was obtained with two randomised trials showing significant activity of the combination of cisplatin and a folate antagonist, pemetrexed or raltitrexed, with a significantly improved median survival time (MST) in patients with MPM. The European Organisation for Research and Treatment of Cancer (EORTC) initiated a phase II trial to evaluate the feasibility of trimodality therapy in a multicentre international setting (EORTC protocol 08031). Objective: To report on the experience with radical surgery, with emphasis on the long-term outcome, for malignant pleural mesothelioma (MPM) at a single institution.

    Methods
    From our database over a 20-year period, we reviewed 53 consecutive patients undergoing radical surgery for MPM in a multimodality programme. The long-term overall survival was analysed using the Kaplan–Meier method.

    Results
    A total of 53 patients (35 males, median age: 60 years) underwent an pleurectomy /Decorticacion 20(37%),pleural drenage and pleurodesis 30(55%) , extra-pleural pneumonectomy (EPP) 5(8%) with a palliativ/ curative intent . Epitheliod MPM was the most frequent (82%) cause. A right-sided disease was present in half of the cases 28 patients (52%). The International Mesothelioma Interest Group (IMIG) stage of the disease was stage I in 5 patients (8%) ,stage II in 19 patients (37%),stage III në 24 patient ( 47%) dhe stadi IV in 5 patients (8%). Preoperative chemotherapy consisting of a doublet cisplatin–pemetrexed (mean of three cycles) was offered to 3 patients (6%). Postoperative therapies, either chemotherapy or radiotherapy, were given in 15 patients (28%). The 30-day and 90-day mortality rates were 2 pateients (4%) and 5patients (8%), respectively. Postoperative complications occurred in 25 % and were major in 3 patients (6%). Re-operation was necessary in 3 case (6%) for one of the following reasons:pleural fistula (n = 1), bleeding (n = 1), and empyaema (n = 1). The mean hospital stay was 20 days. The median survival was 16 months, while the overall 1-, 2- and 5-year survival rates were 60%, 30% and 10%, respectively.

    Conclusion
    These results concur with the published data of the most experienced centre with regards to the mortality and morbidity after EPP for MPM. If a patient with epithelioid MPM is fit enough to tolerate a thoracotomy then macroscopic clearance of the tumour is the preferred option as part of a multimodality regime including chemotherapy.