title: Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine followed by adjuvant chemotherapy in patients with malignant pleural mesothelioma.
abstract: BACKGROUND
  Malignant pleural mesothelioma is a fatal neoplasm related to asbestos exposure. We investigated the effects of pleurectomy/decortication (P/D), hyperthermic pleural lavage with povidone-iodine and adjuvant chemotherapy in patients with malignant pleural mesothelioma.
  
  
  METHODS
  Observational prospective study of patients referred for multimodality therapy and operated on at our institution between October 2004 and May 2010. Thirty-six selected patients underwent P/D and hyperthermic pleural lavage, prophylactic radiotherapy, and adjuvant chemotherapy. All patients were reviewed at 4 weeks and then 6 monthly in the outpatient clinic, with positron-emission tomography-computed tomography. Second-line treatments were administered when appropriate.
  
  
  RESULTS
  Thirty-day mortality was nil. Nine patients experienced postoperative complications: persistent air leak (n = 5, 13.9%), chylothorax requiring surgical intervention (n = 4, 11%), and adult respiratory distress syndrome (n = 1, 3.9%). Fourteen of 36 patients were alive at last follow-up (median follow-up: 33 months, range: 12-63 months). Ten patients were alive with no evidence of disease recurrence, four patients were alive with disease recurrence, and 22 patients had died of disease progression. Overall median survival (Kaplan-Meier) was 24 months (95% confidence interval: 18.5-29.4 months). One-year survival was 91.7%, and 2-year survival was 61%. Patients undergoing complete macroscopical resection (R0-R1) had a significantly better survival than those undergoing an incomplete macroscopical resection (R2) (median overall survival: 32 months versus 18.9 months, p = 0.012).
  
  
  CONCLUSIONS
  In our experience, P/D combined with hyperthermic pleural lavage with povidone-iodine and adjuvant chemotherapy is a well-tolerated multimodality treatment associated with low morbidity and mortality. This multimodality treatment compares favorably with classical trimodality regimens involving chemotherapy, extrapleural pneumonectomy, and adjuvant radiotherapy, in our experience. Study limitations include small sample size, nonrandomization, and patient selection bias.
authors.affiliation: Department of Thoracic Surgery, Oncology, and Histopathology, Guy's and St Thomas Hospital, London, UK. loic.lang-lazdunski@gstt.nhs.uk
authors.forename: Loïc
authors.initials: L
authors.lastname: Lang-Lazdunski
authors.forename: Andrea
authors.initials: A
authors.lastname: Bille
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Belcher
authors.forename: Paul
authors.initials: P
authors.lastname: Cane
authors.forename: David
authors.initials: D
authors.lastname: Landau
authors.forename: Jeremy
authors.initials: J
authors.lastname: Steele
authors.forename: Henry
authors.initials: H
authors.lastname: Taylor
authors.forename: James
authors.initials: J
authors.lastname: Spicer
mesh_terms: D000368:Aged; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008654:Mesothelioma / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000628:therapy*; D011013:Pneumonectomy; D049268:Positron-Emission Tomography; D011206:Povidone-Iodine / Q000627:therapeutic use*; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine