Author of

• 12736

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  P3.14 - Poster Session 3 - Mesothelioma (ID 197)

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

  • 12744

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    P3.14-008 - Resection and Heated Pleural Chemoperfusion for Epithelioid Malignant Pleural Mesothelioma; A Single Center Experience (ID 2276)

    09:30 - 09:30  |  Author(s): A. Yellin
    • Abstract

    Background
    Patients with malignant pleural mesothelioma (MPM) may be treated aggressively by a multimodality approach including radical resection with a curative intent. Yet, a large proportion of them fail locally. One of the measures to reduce local relapse is heated pleural chemoperfusion (HPCP) with platinum based compounds. We report the results of a combined treatment consisting of resection and HCPC in patients with epitheloid MPM (EMPM).

    Methods
    A single center retrospective study of 48 patients with EMPM scheduled for the combined approach over a 16 years period. Surgery consisted of extrapleural pneumonectomy (EPP), or lesser resections (LR), followed by HPCP with cisplatinum, 100mg/m[2] at >42[o]C for 60 min. Survival analysis was done with the Kaplan-Meier method and comparisons between groups with chi square analysis.

    Results
    Of the 48 pts only 42 had both resection and perfusion. Operative mortality was 6.2%; all fatalities occurring after EPP. There was no toxicity. EPP was performed in 72% of advanced stage (AJCCS III+IV) compared to 54% in early stage (AJCCS I+II) disease (p=0.238). Major and minor morbidity were 8(27%) and 9(32%) Vs. 2(16%) and 3(25%), for EPP and LR respectively. The Overall median survival was 14.6 (11.1-18.2, CI-95%); 13.4 months (3.4-23.5, CI-95%) and 28.3 (7.7-48.9, CI-95%) months for EPP and LR respectively (p=0.079). Patients undergoing EPP+HPCP for advanced stage EPMP (n=21) had a median survival of 21.6 months (2.0-43.0, CI-95%). Local control was achieved in 87.5% of the EPP group and 42% of the LR group (p<0.007). The common sites of relapse or progression were ipsilateral pleura (n=9), contralateral pleura (n= 7) and peritoneum (n=5). Early stage disease (I+II) had a survival not significantly better then late stage disease (III+IV).

    Conclusion
    In a center with low-volume surgery for mesothelioma, resection and HPCP can be performed with acceptable mortality and morbidity and no toxicity. In EMPM, HPCP does not reduce local relapse after resections lesser than EPP. In advanced stage EMPM, EPP coupled with HCPC seems to reduce the rate of local relapse, and may contribute to a relatively long survival. The role of HCPC in conjunction with surgery should be further investigated. Figure 1