title: Cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy in patients with malignant pleural mesothelioma or pleural metastases of thymoma.
abstract: OBJECTIVE
  No established curative treatment is available for pleural thymoma metastases and malignant pleural mesothelioma (MPM). Recently, peritoneal malignancies have been treated by cytoreductive surgery and intraoperative hyperthermic intracavitary perfusion chemotherapy (HIPEC). We investigated the feasibility and safety of this multimodality treatment in the thoracic cavity.
  
  
  METHODS
  Patients with pleural thymoma metastases or early-stage MPM were enrolled in a feasibility study. Morbidity, recurrence, and survival rates were recorded.
  
  
  METHODS
  The Netherlands Cancer Institute.
  
  
  METHODS
  Three patients with pleural thymoma metastases and 11 patients with pleural mesothelioma were treated.
  
  
  METHODS
  Cytoreductive surgery and intraoperative hyperthermic intrathoracic perfusion chemotherapy (HITHOC) with cisplatin and adriamycin were performed. The mesothelioma patients received adjuvant radiotherapy on the thoracotomy wound and drainage tracts.
  
  
  RESULTS
  Morbidity and mortality rates were 47% and 0%, respectively. Reoperation was necessary in four cases. Severe chemotherapy-related complications were not observed. A solitary mediastinal and a contralateral pleural thymoma recurrence were successfully treated by radiotherapy and a contralateral HITHOC procedure. All thymoma patients were alive and free of disease after a mean follow-up period of 18 months. After a mean follow-up period of 7.4 months, nine mesothelioma patients are alive. Two mesothelioma patients died of contralateral pleural and peritoneal recurrent disease, while one patient is alive with locoregional recurrence.
  
  
  CONCLUSIONS
  Cytoreductive surgery and HITHOC with cisplatin and adriamycin is feasible in patients with pleural thymoma metastases and early-stage MPM, and is associated with acceptable morbidity rates. Early data on locoregional disease control are encouraging, and a phase II study will be conducted.
authors.affiliation: Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Eelco
authors.initials: E
authors.lastname: de Bree
authors.forename: Serge
authors.initials: S
authors.lastname: van Ruth
authors.forename: Paul
authors.initials: P
authors.lastname: Baas
authors.forename: Emiel J Th
authors.initials: EJ
authors.lastname: Rutgers
authors.forename: Nico
authors.initials: N
authors.lastname: van Zandwijk
authors.forename: Arjen J
authors.initials: AJ
authors.lastname: Witkamp
authors.forename: Frans A N
authors.initials: FA
authors.lastname: Zoetmulder
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000628:therapy*; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D015996:Survival Rate; D013945:Thymoma / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D013953:Thymus Neoplasms / Q000473:pathology*
chemical_list: D000970:Antineoplastic Agents; D004317:Doxorubicin; D002945:Cisplatin