Pleuropneumonectomy in the treatment of malignant pleural mesothelioma.
OBJECTIVE
Malignant pleural mesothelioma (MPM) is predominantly a local/regional disease that results in a survival time that ranges from 4 to 12 months without treatment. Single-modality therapy using surgery, chemotherapy, or radiotherapy alone is largely ineffective. The objective of the study was presentation of the use of pleuropneumonectomy in a multimodality treatment setting and the results.


METHODS
Didactic presentation.


METHODS
Academic tertiary-care hospital.


METHODS
One hundred eighty-three patients who underwent multimodality therapy.


METHODS
Of all the single-modality treatment approaches, pleuropneumonectomy has been associated most consistently with long-term disease-free survival and has provided the greatest amount of tumor cytoreduction. The technique of pleuropneumonectomy traditionally has been linked with high perioperative mortality and morbidity when compared with that of other cytoreductive techniques such as pleurectomy/decortication. Recently, improvements in operative mortality (< 5%) have been reported, largely due to improvements in patient selection and perioperative management. Multimodality therapy, including chemotherapy, radiotherapy, and extrapleural pneumonectomy, was used to treat patients.


RESULTS
Outcomes were presented for 183 patients with MPM who underwent multimodality therapy.


CONCLUSIONS
With the development of multimodality therapy, pleuropneumonectomy followed by sequential chemotherapy and radiotherapy has demonstrated a significant survival benefit, especially for patients who have epithelial tumor histology, tumor-free resection margins, and tumor-free extrapleural node status.
Grondin
S C
SC
Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Sugarbaker
D J
DJ
D000970:Antineoplastic Agents / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008654:Mesothelioma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000627:therapeutic use; D018579:Patient Selection; D010994:Pleura / Q000601:surgery*; D010997:Pleural Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects; D011183:Postoperative Complications; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D016190:Carboplatin; D017239:Paclitaxel