Multimodal Treatment of Malignant Pleural Mesothelioma: Real-World Experience with 112 Patients

Abstract

Malignant pleural mesothelioma (MPM) is a rare pleural cancer associated with asbestos exposure. According to current evidence, the combination of chemotherapy, surgery and radiotherapy improves patients’ survival. However, the optimal sequence and weighting of the respective treatment modalities is unclear. In anticipation of the upcoming results of the MARS-2 trial, we sought to determine the relative impact of the respective treatment modalities on complications and overall survival in our own consecutive institutional series of 112 patients. Fifty-seven patients (51%) underwent multimodality therapy with curative intent, while 55 patients (49%) were treated with palliative intent. The median overall survival (OS) of the entire cohort was 16.9 months (95% CI: 13.4–20.4) after diagnosis; 5-year survival was 29% for patients who underwent lung-preserving surgery. In univariate analysis, surgical treatment (p < 0.001), multimodality therapy (p < 0.001), epithelioid subtype (p < 0.001), early tumor stage (p = 0.02) and the absence of arterial hypertension (p = 0.034) were found to be prognostic factors for OS. In multivariate analysis, epithelioid subtype was associated with a survival benefit, whereas the occurrence of complications was associated with worse OS. Multimodality therapy including surgery significantly prolonged the OS of MPM patients compared with multimodal therapy without surgery.

Lung-sparing decortication pleurectomy with intraoperative adjuvant therapy for malignant mesothelioma: a single institute experience in Taiwan

“…The overall median survival was 14.0 months (95% con dence interval [CI], 5.9-22.0), the 1-year survival was 55.6%, and the 2-year survival rate was 31.7%. Although our outcome is not satisfactory compared with those reported by the best highvolume centers in the world, [10,11] the results are still better than the results obtained from chemotherapy alone in Taiwan. In fact, one of our patients survived about 6 years.…”