title: Multicenter trial of neo-adjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma.
abstract: BACKGROUND
  The aim of this multicenter trial was to prospectively evaluate neo-adjuvant chemotherapy followed by extrapleural pneumonectomy (EPP) and radiotherapy, including quality of life as outcome.
  
  
  METHODS
  Eligible patients had malignant pleural mesothelioma of all histological types, World Health Organization performance status of zero to two and clinical stage T1-T3, N0-2, M0 disease considered completely resectable. Neo-adjuvant chemotherapy consisted of three cycles of cisplatin and gemcitabine followed by EPP. Postoperative radiotherapy was considered for all patients.
  
  
  RESULTS
  In all, 58 of 61 patients completed three cycles of neo-adjuvant chemotherapy. Forty-five patients (74%) underwent EPP and in 37 patients (61%) the resection was complete. Postoperative radiotherapy was initiated in 36 patients. The median survival of all patients was 19.8 months [95% confidence interval (CI) 14.6-24.5]. For the 45 patients undergoing EPP, the median survival was 23 months (95% CI 16.6-32.9). Psychological distress showed minor variations over time with distress above the cut-off score indicating no morbidity with 82% (N = 36) at baseline and 76% (N = 26) at 3 months after surgery (P = 0.5).
  
  
  CONCLUSIONS
  The observed rate of operability is promising. A median survival of 23 months for patients undergoing EPP compares favourably with the survival reported from single center studies of upfront surgery. This approach was not associated with an increase in psychological distress.
authors.affiliation: Department of Thoracic Surgery, University Hospital Zurich, Switzerland.
authors.forename: W
authors.initials: W
authors.lastname: Weder
authors.forename: R A
authors.initials: RA
authors.lastname: Stahel
authors.forename: J
authors.initials: J
authors.lastname: Bernhard
authors.forename: S
authors.initials: S
authors.lastname: Bodis
authors.forename: P
authors.initials: P
authors.lastname: Vogt
authors.forename: P
authors.initials: P
authors.lastname: Ballabeni
authors.forename: D
authors.initials: D
authors.lastname: Lardinois
authors.forename: D
authors.initials: D
authors.lastname: Betticher
authors.forename: R
authors.initials: R
authors.lastname: Schmid
authors.forename: R
authors.initials: R
authors.lastname: Stupp
authors.forename: H B
authors.initials: HB
authors.lastname: Ris
authors.forename: M
authors.initials: M
authors.lastname: Jermann
authors.forename: W
authors.initials: W
authors.lastname: Mingrone
authors.forename: A D
authors.initials: AD
authors.lastname: Roth
authors.forename: A
authors.initials: A
authors.lastname: Spiliopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010997:Pleural Neoplasms / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D011013:Pneumonectomy; D011788:Quality of Life; D011878:Radiotherapy; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine