Surgery followed by intracavitary plus systemic chemotherapy in malignant pleural mesothelioma.
OBJECTIVE
Malignant mesothelioma is associated with a median survival of 4 to 12 months. Data from the literature indicate that single modality treatment (surgery or intrapleural and/or systemic chemotherapy) does not significantly affect survival.


METHODS
We therefore evaluated a combined approach consisting of surgery (pleurectomy + diaphragmatic or pericardial resection), intrapleural chemotherapy with cisplatin (100 mg/m2) and cytarabine (1,000 mg/m2) for 4 h immediately after pleurectomy, and systemic chemotherapy consisting of epirubicin (60 mg/m2) and mitomycin-C (10 mg/m2) day 1 every 4 weeks for 4 cycles.


RESULTS
Twenty patients were enrolled in the study and were evaluable. Thirteen cases had residual gross disease after pleurectomy and 7 patients only minimal disease. Median time to disease progression was 7.4 months, and median survival was 11.5 months (range, 2-25+). No treatment-related death have been observed. Side effects after intracavitary chemotherapy included renal toxicity, anaemia and pain. Myelosuppression and alopecia were recorded during systematic chemotherapy.


CONCLUSIONS
The results of the study indicate that the schedule is feasible, with encouraging results in terms of survival for patients with minimal residual disease after surgery.
Colleoni
M
M
Division of Medical Oncology, City Hospital, Castelfranco Veneto (Tv), Italy.
Sartori
F
F
Calabro
F
F
Nelli
P
P
Vicario
G
G
Sgarbossa
G
G
Gaion
F
F
Bortolotti
L
L
Toniolo
L
L
Manente
P
P
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000628:therapy*; D008875:Middle Aged; D010994:Pleura / Q000601:surgery; D010997:Pleural Neoplasms / Q000628:therapy*