Radical pleurectomy/decortication followed by high dose of radiation therapy for malignant pleural mesothelioma. Final results with long-term follow-up

Minatel, Emilio; Trovò, Marco; Polesel, Jerry; Baresic, Tanja; Bearz, Alessandra; Franchin, Giovanni; Gobitti, Carlo; Rumeileh, Imad Abu; Drigo, A.; Fontana, Paolo; Pagan, V.; Trovò, M.

doi:10.1016/j.lungcan.2013.10.013

Cited by 74 publications

(52 citation statements)

References 18 publications

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“…However, rates of local and distant failure are high and appear early in the course of the disease [6,7]. Little is known about the precise pattern of relapse after multimodality treatment including EPP [7][8][9][10][11] and even fewer data exist on the clinically most relevant question of how the course of the disease can be influenced by implementing a second line treatment after recurrence.…”

Section: Introductionmentioning

confidence: 99%

Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma

Kostron

Friess

Crameri

et al. 2015

Eur J Cardiothorac Surg

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OBJECTIVES: To analyse the relapse pattern and influence of second-line treatment after recurrence of malignant pleural mesothelioma (MPM) in patients who had previously undergone multimodality treatment. METHODS:Between September 1999 and December 2013, 136 patients underwent macroscopic complete resection (MCR) by extrapleural pneumonectomy after induction chemotherapy for MPM. We analysed 106 patients who presented with recurrent disease until October 2014. Data were retrieved from our mesothelioma database, with additional information regarding precise localization gathered by reviewing the imaging and medical records. RESULTS:The overall recurrence rate was 78% (106/136 patients). The median freedom from recurrence was 9 months after surgery [95% confidence interval (95% CI) 7-10]. Local recurrence only was observed in 33 patients (31%), distant metastases only in 27 patients (26%) and simultaneous distant and local recurrence in 46 patients (43%). Local recurrence was observed significantly less frequently in patients having received adjuvant radiotherapy (19 vs 47%, P = 0.003), but there was no significant impact on overall survival (OS) [radiation: 22 months (95% CI 19-24); no-radiation: 23 months (95% CI 18-27), P = 0.6]. The median OS was 22 months (95% CI 21-24), median postrecurrence survival (PRS) was 7 months (95% CI 5-9) and patients with local recurrence only survived significantly longer (12 months, 95% CI 8-16) compared with patients with distant recurrence only (5 months, 95% CI 2-8) or distant plus local relapse (6 months, 95% CI 3-9; P = 0.04). A total of 78 patients received a second-line therapy after tumour recurrence: chemotherapy (n = 48), local radiotherapy (n = 9), surgery (n = 10) or a combination thereof (n = 11). Patients undergoing second-line treatment survived significantly longer compared with patients not receiving therapy (P < 0.0005). The median PRS after surgery was significantly longer than that of patients receiving chemo-, radio-or chemo-radiotherapy (P = 0.04).CONCLUSIONS: Local recurrence of MPM remains the most frequent type of relapse even after multimodality treatment including MCR. In the present cohort, active treatment seems beneficial to the patient since surgical excision of local tumour relapse has good long-term outcome in selected patients. Thus, second-line treatment may prolong PRS; however, these results need to be confirmed in a prospective manner.

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Section: Introductionmentioning

confidence: 99%

Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma

Kostron

Friess

Crameri

et al. 2015

Eur J Cardiothorac Surg

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“…Another recent study in a general MPM population found that 24% of patients survived more than 20 months, but only 66 and 16% of them had received CT and EPP, respectively [3]. Overall, the percentage of patients surviving more than 3 years was about 10-15% in populationbased studies, growing to 18-68% in patients who underwent surgery [5,20,26,27].…”

Section: Discussionmentioning

confidence: 98%

Clinical Features and Treatment Outcome of Malignant Pleural Mesothelioma

Filiberti

Taveggia²,

Grosso

et al. 2017

Oncol Res Treat

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Background: Malignant pleural mesothelioma is a problematic condition due to poor prognosis and difficulties in management. We evaluated the treatment and outcome of 378 mesothelioma patients referred to 6 Italian Oncology Departments. Methods: Demographic and clinical data were collected. Treatment was assessed in terms of chemotherapy (line of treatment, pemetrexed-based regimen, other therapies), surgery, and radiotherapy. Response to therapy, progression-free survival, and overall survival were evaluated. Results: 36 and 342 patients received best supportive care and active treatment, respectively; 86 patients underwent surgery, and 26 received trimodal therapy. Disease control after first-line chemotherapy was achieved in 74.2% of patients (75.7% in patients treated with pemetrexed combined with other drugs and 69% with pemetrexed as monotherapy). The disease control rate was 82.6% in pemetrexed re-challenged individuals. Median survival time was 11.6 months with supportive care, 16.2 months with chemotherapy only, 32.4 months with surgery plus chemotherapy, and 47.2 months with trimodal therapy. A more favorable prognosis was observed in responders to first-line therapy who were then actively treated with second-line (24.8 vs. 11.8 months in non-responders, p < 0.001) and third-line chemotherapy (28.9 vs. 17.8 months in non-responders, p = 0.005). Conclusion: Mesothelioma patients benefited from chemotherapy alone only when retreated in the second line after response to first-line therapy.

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“…In all published experiences of lung-sparing IMRT in MPM, irradiation of the whole pleura has been performed [10][11][12][13][14][15][16]. The clinical target volume (CTV) consisted of the whole pleural space, contoured from the lung apex to the diaphragm insertion (T12-L2).…”

Section: Discussionmentioning

confidence: 99%

“…The clinical target volume (CTV) consisted of the whole pleural space, contoured from the lung apex to the diaphragm insertion (T12-L2). Median doses to the planning target volume ranged from 47 to 50 Gy [10][11][12][13][14][15][16]. In all cases, PET/CT was frequently (but not routinely) used to modify the CTV, with the inclusion of any FDG-avid area.…”

Section: Discussionmentioning

confidence: 99%

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Optimal gross tumor volume definition in lung-sparing intensity modulated radiotherapy for pleural mesothelioma: an in silico study

et al. 2016

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Radical pleurectomy/decortication followed by high dose of radiation therapy for malignant pleural mesothelioma. Final results with long-term follow-up

Cited by 74 publications

References 18 publications

Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma

Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma

Clinical Features and Treatment Outcome of Malignant Pleural Mesothelioma

Optimal gross tumor volume definition in lung-sparing intensity modulated radiotherapy for pleural mesothelioma: an in silico study

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