title: Intrathoracic chemo-thermotherapy with radiofrequency waves after extrapleural pneumonectomy for malignant pleural mesothelioma.
abstract: Although multimodal treatment is advocated for malignant pleural mesothelioma (MPM), a standard therapeutic regimen has not been established. This study evaluated the outcome of our aggressive treatment including extrapleural pneumonectomy (EPP) and postoperative intrathoracic chemo-thermotherapy (PICT). Moreover, we assessed the association between the clinical effect and an in vitro chemosensitivity test. Eleven patients with MPM underwent treatment including EPP followed by PICT using 8 MHz radiofrequency waves. In vitro chemosensitivity was examined using the collagen gel droplet embedded culture drug-sensitivity test (CD-DST). Complete resection was performed in nine patients. More than two courses of PICT with sufficient heating were completely performed in seven patients. There was no perioperative mortality. Grade 3 or 4 toxicity was not recognized. The median overall survival was 19 months, and the median local relapse-free survival was 17 months. Local recurrence was recognized in four patients (36.4%). Of these patients, three had received incomplete PICT. Four patients with complete PICT including a CD-DST-sensitive chemoagent did not develop local recurrence. Of three patients who received complete PICT including a CD-DST-resistant chemoagent, one tumor recurred locally. The present multimodal treatment including EPP and PICT is promising in local control for MPM. Furthermore, CD-DST may provide clinically useful information for MPM.
authors.affiliation: Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. tokunaga-to@mc.pref.osaka.jp
authors.forename: Toshiteru
authors.initials: T
authors.lastname: Tokunaga
authors.forename: Masahiko
authors.initials: M
authors.lastname: Higashiyama
authors.forename: Jiro
authors.initials: J
authors.lastname: Okami
authors.forename: Jun
authors.initials: J
authors.lastname: Maeda
authors.forename: Ayako
authors.initials: A
authors.lastname: Fujiwara
authors.forename: Ken
authors.initials: K
authors.lastname: Kodama
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016190:Carboplatin / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage*; D018572:Disease-Free Survival; D004354:Drug Screening Assays, Antitumor; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects / Q000401:mortality; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D002945:Cisplatin