title: A phase II study of intrapleural immuno-chemotherapy, pleurectomy/decortication, radiotherapy, systemic chemotherapy and long-term sub-cutaneous IL-2 in stage II-III malignant pleural mesothelioma.
abstract: OBJECTIVE
  From therapeutic nihilism to extremely aggressive management, there is a wide range of possibilities in the treatment of malignant pleural mesothelioma (MPM). Unfortunately, there is little evidence as regards the best treatment to offer to the MPM patients. In 1999, we started a phase II study based on the multimodality treatment of stage II-III MPM, the results of which have been analysed and reported.
  
  
  METHODS
  From 1999 to 2004, 49 patients with IMIG stage II-III MPM underwent a multimodality treatment including: intrapleural pre-operative interleukin 2 (IL-2, 18x10(6) UI/day per 3 days), pleurectomy/decortication, intrapleural post-operative epidoxorubicin (25mg/m2 per 3 days), IL-2 (18x10(6) UI/day per 3 days), adjuvant radiotherapy (30Gy), systemic chemotherapy (cisplatin 80 mg/m2 day 1, gemcitabine 1250 mg/m2 day 1 and 8 up to 6 courses) and long-term sub-cutaneous IL-2 (3x10(6) UI/day 3 days per week).
  
  
  RESULTS
  There were 41 males and 8 females with a median age of 61 years (range 41-77). All the patients had a diagnosis of MPM by thoracoscopy before inclusion. We did not experience any post-operative mortality. The histology was: 39 epitheliomorf, 6 bifasic and 4 sarcomatous. According to the IMIG the post-operative staging was III in 40 cases and II in 9 cases. With a median follow-up of 59 months (range 14-81) 13 patients are still alive and the median actuarial survival is 26 months (31 and 21 months for stage II and III, respectively). Only the Performance Status at the diagnosis affected survival significantly.
  
  
  CONCLUSIONS
  The multimodality treatment we adopted for stage II-III MPM was feasible, well tolerated by most of the patients and produced a favourable outcome. New targeted therapies are awaited for further improvements in the treatment of this disease.
authors.affiliation: Division of Thoracic Surgery, Cardiac and Thoracic Department, University of Pisa, Pisa, Italy. m.lucchi@med.unipi.it
authors.forename: Marco
authors.initials: M
authors.lastname: Lucchi
authors.forename: Antonio
authors.initials: A
authors.lastname: Chella
authors.forename: Franca
authors.initials: F
authors.lastname: Melfi
authors.forename: Paolo
authors.initials: P
authors.lastname: Dini
authors.forename: Marcello
authors.initials: M
authors.lastname: Ambrogi
authors.forename: Leonardo
authors.initials: L
authors.lastname: Fino
authors.forename: Gabriella
authors.initials: G
authors.lastname: Fontanini
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mussi
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000379:methods; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007376:Interleukin-2 / Q000627:therapeutic use; D008297:Male; D008654:Mesothelioma / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D010994:Pleura / Q000601:surgery*; D010997:Pleural Neoplasms / Q000473:pathology / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D007376:Interleukin-2