title: Patterns of failure after trimodality therapy for malignant pleural mesothelioma.
abstract: BACKGROUND
  Malignant pleural mesothelioma is uncommon, and presently, no standard treatment of this disease exists. The objective of our analysis was to study the patterns of failure for malignant pleural mesothelioma after trimodality treatment consisting of extrapleural pneumonectomy, chemotherapy, and radiation therapy.
  
  
  METHODS
  Between 1987 and 1993, 49 patients with malignant pleural mesothelioma underwent extrapleural pneumonectomy. There were two perioperative deaths, and 1 patient died 5 weeks after extrapleural pneumonectomy. Thirty-five of the surviving patients received adjuvant chemotherapy (32/35 received cyclophosphamide, doxorubicin, and cisplatin) followed by hemithorax radiation therapy. Ten patients received chemotherapy but no radiation therapy, and 1 patient received no adjuvant therapy. Median follow-up time for the 23 living patients from the date of operation was 18 months.
  
  
  RESULTS
  Of the 46 evaluable patients, 25 had recurrence (54%), with a median time to first failure of 19 months (range, 5 to 51 months). The sites of first recurrence were local in 35% of patients, abdominal in 26%, the contralateral thorax in 17%, and other distant sites in 8%. (Some patients had recurrence in multiple sites simultaneously.)
  
  
  CONCLUSIONS
  The most common site of failure after trimodality therapy was the ipsilateral hemithorax. Isolated distant failures were uncommon. Future strategies should investigate methods of enhancing local tumor control.
authors.affiliation: Joint Center for Radiation Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: E H
authors.initials: EH
authors.lastname: Baldini
authors.forename: A
authors.initials: A
authors.lastname: Recht
authors.forename: G M
authors.initials: GM
authors.lastname: Strauss
authors.forename: M M
authors.initials: MM
authors.lastname: DeCamp
authors.forename: S J
authors.initials: SJ
authors.lastname: Swanson
authors.forename: M J
authors.initials: MJ
authors.lastname: Liptay
authors.forename: S J
authors.initials: SJ
authors.lastname: Mentzer
authors.forename: D J
authors.initials: DJ
authors.lastname: Sugarbaker
mesh_terms: D000008:Abdominal Neoplasms / Q000556:secondary; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011013:Pneumonectomy; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis; D013899:Thoracic Neoplasms / Q000556:secondary; D017211:Treatment Failure