Online citations, reference lists, and bibliographies.
← Back to Search

Trimodality Management Of Malignant Pleural Mesothelioma.

G. Maggi, C. Casadio, R. Cianci, O. Rena, E. Ruffini
Published 2001 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
OBJECTIVE We reviewed our experience with trimodality management of malignant pleural mesothelioma (MPM). METHODS From September 1998 to August 2000, 32 consecutive patients with histological diagnosis of MPM underwent trimodality therapy, including surgery followed by adjuvant chemotherapy and radiation therapy. Surgery consisted of pleurectomy/decortication (P/D) or pleural-pericardial-pneumonectomy and diaphragm (PPPD). Pre-operative staging according to the Brigham Staging System was accomplished using computed tomography (CT) and magnetic resonance imaging (MRI); patients with evident extrapleural spread were excluded. RESULTS Our series included 21 men and 11 women with a median age of 53.5 years (range 40-69). Histologically, there were 26 epithelial, four mixed and two sarcomatous MPM. Post-surgical staging was as follows: six patients were at Stage I; of these, two received a P/D and four a PPPD. Ten patients were at Stage II and all received a PPPD; 16 patients were at Stage III (under-staged pre-operatively): of these, nine patients presented extrapleural lymph node metastases (N2) and all received a PPPD, seven patients presented with chest wall or mediastinal invasion (T4) with macroscopic residual tumour, and all received a de-bulking P/D. We observed major complications in ten patients: six bleeding, two respiratory insufficiency and two nerve paralysis. There were two perioperative deaths (6.25% mortality). Twenty-seven patients out of 30 surviving surgery had a follow-up greater than 6 months; 21 patients out of 27 are alive with a median follow-up of 12.5 months. CONCLUSIONS (1) Trimodality therapy is feasible in selected patients with MPM and has an acceptable operative mortality rate. (2) Our current pre-operative staging based on CT/MRI looks rather inaccurate and needs to be improved. (3) The high rate of post-surgical N2 patients or with diffusion to the inferior surface of the diaphragm may suggest the use of routine mediastinoscopy and laparoscopy for a more appropriate patient selection.
This paper references
Recent trends in mesothelioma incidence in the United States.
R. Spirtas (1986)
Extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma.
D. Sugarbaker (1992)
Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma.
D. Sugarbaker (1993)
Extrapleural pneumonectomy, chemotherapy, and radiotherapy in the treatment of diffuse malignant pleural mesothelioma.
D. Sugarbaker (1991)
The European mesothelioma epidemic
J. Peto (1999)
Malignant mesothelioma of the pleura: clinical aspects and symptomatic treatment.
M. Law (1984)
The importance of surgical staging in the treatment of malignant pleural mesothelioma.
V. Rusch (1996)
Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients.
E. Butchart (1976)
Pleural mesothelioma in Sweden: an analysis of the incidence according to the use of asbestos.
B. Järvholm (1999)
The role of extrapleural pneumonectomy in malignant pleural mesothelioma. A Lung Cancer Study Group trial.
V. Rusch (1991)
Effets sur la santé des principaux types d'exposition à l'amiante
D. Douguet (1997)
Pleural malignant mesothelioma and environmental asbestos exposure in Casale Monferrato, Piedmont. Preliminary analysis of a case-control study.
C. Magnani (1997)
Extrapleural pneumonectomy for diffuse, malignant mesothelioma.
M. Davalle (1986)
Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients.
D. Sugarbaker (1999)

This paper is referenced by
Progress in the management of malignant pleural mesothelioma
M. Krzakowski (2005)
The effect of extent of local resection on patterns of disease progression in malignant pleural mesothelioma.
D. Stewart (2004)
Preoperative Chemotherapy and Surgery
E. Vallières (2005)
Biology and management of malignant pleural mesothelioma.
P. Zucali (2006)
Treatment of Malignant Pleural Mesothelioma: Is There a Benefit to Pleuropneumonectomy?
S. Su (2007)
CD 157 enhances malignant pleural mesothelioma aggressiveness and predicts poor clinical outcome
E. Ortolan (2014)
Treatment of mesothelioma in Bloemfontein, South Africa.
W. de Vries (2003)
Surgical management of malignant pleural mesothelioma: a systematic review and evidence summary.
D. Maziak (2005)
Multimodality strategies in malignant pleural mesothelioma.
W. Weder (2009)
Mesothelioma Prevalence and Pattern of Lymph Node Metastasis in Malignant Pleural
Eman G. Farahat (2013)
Therapy for malignant pleural mesothelioma
H. Pass (2006)
Extrapleural pneumonectomy for malignant mesothelioma: an Italian multicenter retrospective study.
L. Spaggiari (2014)
Treatment of malignant pleural mesothelioma: current status and future directions
P. Zucali (2011)
The case for routine cervical mediastinoscopy prior to radical surgery for malignant pleural mesothelioma.
J. Pilling (2004)
Neoadjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma.
W. Weder (2004)
Radiotherapy in malignant pleural mesothelioma.
M. McAleer (2009)
Malignant Pleural Mesothelioma—An Update
D. Stewart (2004)
Extra-pleural pneumonectomy.
Leonardo Duranti (2019)
Prevalence and pattern of lymph node metastasis in malignant pleural mesothelioma.
A. Abdel Rahman (2008)
Biomarkers for Malignant Pleural Mesothelioma
L. Greillier (2012)
The Evolution of Multimodality Therapy for Malignant Pleural Mesothelioma
M. Zauderer (2011)
BTS statement on malignant mesothelioma in the UK, 2007
Feasibility of boron neutron capture therapy (BNCT) for malignant pleural mesothelioma from a viewpoint of dose distribution analysis.
M. Suzuki (2006)
Survival and relapse pattern after trimodality therapy for malignant pleural mesothelioma
K. Okubo (2009)
Placenta growth factor expression has prognostic value in malignant pleural mesothelioma.
E. Pompeo (2009)
Thymidylate synthase but not excision repair cross-complementation group 1 tumor expression predicts outcome in patients with malignant pleural mesothelioma treated with pemetrexed-based chemotherapy.
L. Righi (2010)
Extrapleural Pneumonectomy for Malignant Mesothelioma The Value of Occult Disease in Resection Margin and Lymph Node After
Paolo Aurea (2011)
Intrapleural topical application of cisplatin with the surgical carrier Vivostat increases the local drug concentration in an immune-competent rat model with malignant pleuromesothelioma.
D. Lardinois (2006)
Photodynamic therapy for mesothelioma
S. Hahn (2001)
ntrapleural topical application of cisplatin with the urgical carrier Vivostat increases the local drug oncentration in an immune-competent rat model with alignant pleuromesothelioma
. Lardinois (2009)
Chemotherapy and radiotherapy for mesothelioma.
X. Dhalluin (2011)
How does the timing of chemotherapy affect outcome following radical surgery for malignant pleural mesothelioma?
A. Sharkey (2016)
See more
Semantic Scholar Logo Some data provided by SemanticScholar