Effect of hemithorax irradiation alone or combined with doxorubicin and cyclophosphamide in 47 pleural mesotheliomas: a nonrandomized phase II study

Cj, Lindén; Mercke, Claes; Albrechtsson, U.; Johansson, Leif; Sb, Ewers

doi:10.1183/09031936.96.09122565

Cited by 52 publications

(23 citation statements)

References 29 publications

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“…The rates of objective tumour regression have only been between 10 and 30% with cytotoxic monotherapy, having no significant impact on median survival. Combination chemotherapy has shown no clear advantage over single-agent therapy (Linden et al, 1996).…”

Section: Role Of Chemotherapymentioning

confidence: 99%

Chemotherapy for malignant pleural mesothelioma: past results and recent developments

Tomek

Manegold

2004

Lung Cancer

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This review summarises the results of previously conducted clinical trials, and subsequently presents data arising from all phase II -III studies on chemotherapy of malignant pleural mesothelioma (MPM) published since the last relevant overview. While response rates exceeding 30% have barely been achieved with established cytotoxic drugs in MPM therapy, novel chemotherapeutic agents and their combinations appear more promising. This applies especially to the antimetabolites, and in particular to pemetrexed that produced response rates of up to 45% in combination with platinum compounds. Raltitrexed combined with oxaliplatin has also been shown to be effective, and gemcitabine -applied as a single agent or in combination with cisplatin -as well as vinorelbine appear to improve the quality of life in patients presenting with MPM. Data can now be more precisely analysed by increasingly implemented randomised studies, applying a standardised staging system, and distinguishing prognostic groups. While chemotherapy for MPM remains a challenging task, important steps have clearly been made in the past years to combat this aggressive disease. The publication of pemetrexed with cisplatin phase III results in a peer-reviewed journal may soon establish a standard of care.

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Section: Role Of Chemotherapymentioning

confidence: 99%

Chemotherapy for malignant pleural mesothelioma: past results and recent developments

Tomek

Manegold

2004

Lung Cancer

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“…Although radiation therapy has shown efficacy on mesothelioma cell lines [77], it has proven disappointing in mesothelioma patients and poor results have been described in several series [78,79]. One of the major problems in performing radiation therapy is determining the volume of the target area, which includes the diaphragm, mediastinum, and chest wall and excludes the lung.…”

Section: Radiation Therapymentioning

confidence: 99%

Malignant pleural mesothelioma

Boutin¹,

Schlesser²,

Frenay³

et al. 1998

Eur Respir J

171

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The incidence of malignant pleural mesothelioma (MPM) has risen for some decades and is expected to peak between 2010 and 2020. Up to now, no single treatment has been proven to be effective and death usually occurs within about 12-17 months after diagnosis. Perhaps because of this poor prognosis, early screening has incited little interest. However, certain forms may have a better prognosis when diagnosed early and treated by multimodal therapy or intrapleural immunotherapy. Diagnosis depends foremost on histological analysis of samples obtained by thoracoscopy. This procedure allows the best staging of the pleural cavity with an attempt to detect visceral pleural involvement, which is one of the most important prognostic factors. Although radiotherapy seems necessary and is efficient in preventing the malignant seeding after diagnostic procedures in patients, there has been no randomized phase III study showing the superiority of any treatment compared with another. However, for the early-stage disease (stage I) a logical therapeutic approach seems to be neoadjuvant intrapleural treatment using cytokines. For more advanced disease (stages II and III) resectability should be discussed with the thoracic surgeons and a multimodal treatment combining surgery, radiotherapy and chemotherapy should be proposed for a randomized controlled study. Palliative treatment is indicated for stage IV. In any case, each patient should be enrolled in a clinical trial.

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“…Median survival was only 4 months. In a second study in Sweden [49], 47 patients received 40 Gy in 20 fractions to the hemithorax; 16 subsequently received doxorubicin and cyclophosphamide. Only 1 of 31 (3%) exhibited a partial response, and the authors reported no favorable effect on chest pain, weight loss, and performance status.…”

Section: Radiotherapy For Palliation Of Symptomsmentioning

confidence: 99%

What Is the Role of Radiotherapy in Malignant Pleural Mesothelioma?

Price

2011

The Oncologist

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Objective. A review of the evidence supporting the use of radiotherapy in patients with mesothelioma was performed.Methods. Relevant publications were searched for on Medline.Results. In a Medline search on radiotherapy and mesothelioma, 611 hits were obtained. A limited number of prospective phase II trials of radiotherapy as part of trimodality protocols for early disease and in the palliation of pain were found, along with three small randomized controlled trials of port-site prophylaxis.Conclusion. No randomized data exist to support the use of radiotherapy after radical surgery, although there are a large number of publications describing its use as an integral part of therapy, including seven phase II studies. One ongoing trial is randomizing patients to radiotherapy or not after extrapleural pneumonectomy. None of these studies provided any assessment of radiotherapy independent of the other modalities investigated, nor did any formally assess intensity-modulated radiotherapy. There have been several reports of excessive toxicity with this technique, and its use should be limited to phase I studies until the basis of this toxicity is better understood. Three trials have looked at port-site prophylaxis, one supporting its use and two showing no evidence of benefit. Two studies addressed pain control prospectively, one showing definite but short-lived benefits.Implications. Radiotherapy is widely used in treating mesothelioma with little supporting evidence. More randomized trials are required to justify this use in all three common settings for its use. The Oncologist 2011; 16:359 -365

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Effect of hemithorax irradiation alone or combined with doxorubicin and cyclophosphamide in 47 pleural mesotheliomas: a nonrandomized phase II study

Cited by 52 publications

References 29 publications

Chemotherapy for malignant pleural mesothelioma: past results and recent developments

Chemotherapy for malignant pleural mesothelioma: past results and recent developments

Malignant pleural mesothelioma

What Is the Role of Radiotherapy in Malignant Pleural Mesothelioma?

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