Survival after trimodality therapy for malignant pleural mesothelioma: Radical Pleurectomy, chemotherapy with Cisplatin/Pemetrexed and radiotherapy

Bölükbas, Servet; Manegold, Christian; Eberlein, Michael; Bergmann, Thomas; Fisseler‐Eckhoff, Annette; Schirren, J.

doi:10.1016/j.lungcan.2009.08.019

Cited by 119 publications

(67 citation statements)

References 29 publications

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“…The tumor histology and lymph node status profoundly affect long term survival and treatment strategy for a patient with mesothelioma. As reported in several recent papers (5,6), MPM with pure epithelioid histology is associated with significantly prolonged survival. Consequently, the authors emphasize the importance of a proper and representative tissue sample for avoiding misclassification of mesothelioma subtype even with the means of more invasive procedures.…”

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confidence: 60%

New concepts in the treatment of malignant pleural mesothelioma

2018

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Malignant pleural mesothelioma (MPM) is an aggressive solid malignancy with a median overall survival of 8 months (1). First line combination therapy of cisplatin and pemetrexed has brought an overall survival benefit of only 11 weeks compared to cisplatin alone (2,3). Despite the limited efficacy of this regimen, it has continued as standard MPM therapy 14 years after its acceptance, underscoring the urgent need for novel treatments that improve the lives of MPM patients. Within this focused review (4), Wald and Sugarbaker elaborate on novel advanced classification and prognostication methods that shine a light on the path to personalized medicine, possibly matching the right therapy with the right patient. Several key principles and evolving concepts in the care of MPM patients are discussed.As well known in MPM, surgical resection of the tumor is a major therapeutic option that is often combined with chemotherapy. A major controversy in this field has been the appropriate identification of patients that would benefit from multimodality treatments (MMT) protocol. In this review the authors also refer to known biomarkers for that aim. The tumor histology and lymph node status profoundly affect long term survival and treatment strategy for a patient with mesothelioma. As reported in several recent papers (5,6), MPM with pure epithelioid histology is associated with significantly prolonged survival. Consequently, the authors emphasize the importance of a proper and representative tissue sample for avoiding misclassification of mesothelioma subtype even with the means of more invasive procedures. In the recent work of Friedberg and colleagues long term outcomes of 73 MPM patients with histology confirmed epithelioid subtype treated with MMT protocol were demonstrated. The median overall and disease-free survival was 3 and 1.2 years, respectively (7). In addition, the authors discuss the changes in the 2016 MPM staging system which are summarized by unification of the previous T1a and T1b tumors into a new T1 category and the unification of the previous N2 lymph nodes into the N1 category based on accumulated prognostic data. In the previous staging system patients with N2 nodes were regarded as stage III with median survival of 14 months while according with the new staging system they belong to stage II group with improvement of 5 months in the median survival. In the paucity of properly established clinical trials comparing chemotherapy to surgery based MMT, we agree with the authors attitude and stress the importance of surgery based MMT protocols for mesothelioma treatment based on retrospective and prospective cohort studies. The international mesothelioma interest group viewpoint as well as the National Comprehensive Cancer Network (NCCN) highlight the important role of surgical macroscopic complete resection (MCR) and control of micro metastatic disease as part of MPM MMT protocols (8). MCR can be achieved by pleurectomy decortication (PD) or by extrapleural pneumonectomy (EPP). Specifically, the most prolo...

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confidence: 60%

New concepts in the treatment of malignant pleural mesothelioma

2018

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“…[10] A trimodality therapeutic approach, utilizing chemotherapy, surgery and hemithoracic radiotherapy, has recently been proposed for the treatment of MPM, with good preliminary results. [11][12][13] The median survival was reported as 11 months. The survival rate however, is influenced by nodal status and response to chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Contemporary radiation therapy techniques in malignant pleural mesothelioma: a case report

Halpern¹,

McVorran

Loksen

2015

JST

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Malignant pleural mesothelioma (MPM) is a rare but very aggressive neoplasm. Prognosis is poor and the disease is fatal within 4-8 months without treatment. Even with a trimodality treatment approach, which has been shown to produce significant morbidity, median survival does not exceed 11 months. There is a need therefore for exploring new treatment options that can improve both qualitative and quantitative outcomes.This case report describes locally advanced malignant pleural mesothelioma treated with a unique, customized irradiation technique involving a combination of 3D conformal therapy and intensity modulated radiotherapy (IMRT). This allowed for treatment of the pleura to a high dose, while sparing the lung parenchyma. In this patient, our approach resulted in a prolonged remission. It is our hope that this stimulates new interest in the use of modern day radiation techniques in the treatment of MPM.

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“…. .very good patients with not a lot of disease were chosen for this approach, and the median survivals of 37 months for Stage I/II disease and 23 months for Stage III/IV support this [5].…”

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confidence: 81%

“…There is no doubt that this standardization makes it easier to compare various series in the literature. But the paper by Bolukbas muddies the waters [5]. These investigators actually dictate that they will not do EPP but prospectively evaluate the role of lung sparing, "radical" pleurectomy decortication with visceral pleurectomy and dissection of the fissures, along with pericardial and diaphragmatic resection.…”

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confidence: 99%

Surgery and mesothelioma: If not randomization, at least standardization and registration!

Pass

2011

Lung Cancer

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Survival after trimodality therapy for malignant pleural mesothelioma: Radical Pleurectomy, chemotherapy with Cisplatin/Pemetrexed and radiotherapy

Cited by 119 publications

References 29 publications

New concepts in the treatment of malignant pleural mesothelioma

New concepts in the treatment of malignant pleural mesothelioma

Contemporary radiation therapy techniques in malignant pleural mesothelioma: a case report

Surgery and mesothelioma: If not randomization, at least standardization and registration!

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