A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma

Rusch, Valerie W.; Rosenzweig, Kenneth E.; Venkatraman, Ennapadam; Leon, Larry; Raben, Adam; Harrison, Louis B.; Bains, Manjit S.; Downey, Robert J.; Ginsberg, Robert J.

doi:10.1067/mtc.2001.116560

Cited by 459 publications

(277 citation statements)

References 34 publications

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“…This is more easily performed after EPP than P/D as there is an empty cavity without remaining lung parenchyma. In a phase II trial of 57 patients undergoing EPP or P/D, a postoperative dose of 54 Gy was administered [34]. Local recurrence was 13% with a median survival time of 17 months, which was lower than historical series.…”

Section: Combined-modality Therapymentioning

confidence: 99%

Multimodal management of malignant pleural mesothelioma: where are we today?

Schil

Opitz²,

Weder³

et al. 2014

Eur Respir J

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The prognosis of patients with malignant pleural mesothelioma remains poor and although it is clear that multimodal therapy is necessary to improve long-term results, precise treatment schemes have not yet been unequivocally established. Single-modality therapy does not have a major impact on long-term survival and combined-modality therapies are being further evaluated. However, the relative contributions of chemotherapy, radiotherapy and surgery have not been clearly determined at the present time. Moreover, the extent of resection and precise surgical procedure remain a highly debated topic. To better compare and combine results from different institutions and trials, uniform definitions of surgical procedures including extrapleural pneumonectomy and different forms of pleurectomy have recently been introduced. Due to the relatively higher morbidity and mortality of extrapleural pneumonectomy, there is currently a shift towards pleurectomy/decortication when a macroscopic complete resection of all tumour can be obtained by this procedure. In most recent trials, induction chemotherapy was administered to improve surgical resection rates but pathological complete responses are infrequently observed. The role of post-operative radiotherapy has to be further elucidated.Further treatment options that are currently explored include hyperthermic intrapleural chemotherapy, immunotherapy, gene therapy and photodynamic therapy. However, no randomised comparisons are available yet. @ERSpublications Treatment of malignant pleural mesothelioma remains controversial

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Section: Combined-modality Therapymentioning

confidence: 99%

Multimodal management of malignant pleural mesothelioma: where are we today?

Schil

Opitz²,

Weder³

et al. 2014

Eur Respir J

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show abstract

“…EPP removes radiation-sensitive lung, so it permits the delivery of higher postoperative doses to the involved hemithorax. A phase II trial conducted at the Memorial Sloan-Kettering Cancer Center demonstrated that a high dose of hemithoracic radiation (54 Gy) following EPP was well tolerated with reduced local recurrence rates and prolonged survival for early-stage MPM [35]. A new solution that produces more conformal dose distributions by saving critical structures is provided by intensity-modulated radiotherapy (IMRT) [36].…”

Section: Radiotherapy For Malignant Pleural Mesotheliomamentioning

confidence: 99%

“…Radiotherapy has often been added to surgery in an attempt to improve local control. It is used as adjuvant therapy after EPP as part of trimodality treatment, which is effective at reducing local recurrence of the tumor and improving overall survival [35].…”

Section: Radiotherapy For Malignant Pleural Mesotheliomamentioning

confidence: 99%

Current therapies for malignant pleural mesothelioma

Nakano

2008

Environ Health Prev Med

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Mesothelioma is a highly lethal tumor derived from mesothelial cells, and its global incidence is increasing because of widespread exposure of numerous individuals to asbestos in the last 50 years. Mesothelioma is largely untreatable with any of the therapeutic modalities. Recently, a novel multitargeted antifolate pemetrexed has shown promising activity against malignant pleural mesothelioma, producing response rates of up to 40% when used in combination with cisplatin. In a large phase III study, use of a combination of pemetrexed and cisplatin was associated with significantly improved survival time and with greater antitumor activity compared with cisplatin alone. This combination also gave a significant response rate of approximately 50% in patients with epithelioid malignant pleural mesothelioma. These clinical benefits of pemetrexed-cisplatin doublet have changed the perception of mesothelioma chemotherapy. Other combinations, including gemcitabine in combination with cisplatin, have also shown encouraging response rates. Prognosis depends on gender, clinical stage of the tumor, histological subtype, platelet count, leukocyte counts, and performance status. Radiotherapy can palliate mesothelioma patients with chest pain, and has been indicated to be of benefit for the prevention of malignant seeding along the tract of a chest tube or needle biopsy. Trimodality treatment using extrapleural pneumonectomy, radiation and chemotherapy has shown promising therapeutic value. The development of chemotherapeutic regimens and the favorable outcomes of trimodality have led to new combined modality trials. In Japan, multicenter national trials against mesothelioma will begin in the near future.

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“…One of the potential intraoperative complications of EPP is hemorrhage, which is associated with a high rate of perioperative transfusions (approximately 90%) [72,74]. Surgeryassociated hemorrhage complicates the postoperative period, frequently requiring reoperation for control of surgical bleeding [72,73].…”

Section: Extrapleural Pneumonectomy For Malignant Pleural Mesotheliomamentioning

confidence: 99%

Blood Loss and Massive Transfusion in Patients Undergoing Major Oncological Surgery: What Do We Know?

Cata

Gottumukkala

2012

ISRN Anesthesiology

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Patients with solid malignancies who were not candidates for tumor resections in the past are now presenting for extensive oncological resections. Cancer patients are at risk for thromboembolic complications due to an underlying hypercoagulable state; however, some patients may have an increased risk for bleeding due to the effects of chemotherapy, the administration of anticoagulant drugs, tumor-related fibrinolysis, tumor location, tumor vascularity, and extent of disease. A common potential complication of all complex oncological surgeries is massive intra-and postoperative hemorrhage and the subsequent risk for massive blood transfusion. This can be anticipated or unexpected. Several surgical and anesthesia interventions including preoperative tumor embolization, major vessel occlusion, hemodynamic manipulation, and perioperative antifibrinolytic therapy have been used to prevent or control blood loss with varying success. The exact incidence of massive blood transfusion in oncological surgery is largely unknown and/or underreported. The current literature mostly consists of purely descriptive observational studies. Thus, recommendation regarding specific perioperative intervention cannot be made at this point, and more research is warranted.

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A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma

Cited by 459 publications

References 34 publications

Multimodal management of malignant pleural mesothelioma: where are we today?

Multimodal management of malignant pleural mesothelioma: where are we today?

Current therapies for malignant pleural mesothelioma

Blood Loss and Massive Transfusion in Patients Undergoing Major Oncological Surgery: What Do We Know?

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