title: Treatment failure after extrapleural pneumonectomy for malignant pleural mesothelioma.
abstract: BACKGROUND
  Extrapleural pneumonectomy (EPP) has been used as a treatment option for selected patients with malignant pleural mesothelioma (MPM). The primary end-point of this study was disease-free survival (DFS). Prognostic indicators for local and overall DFS were statistically analyzed.
  
  
  METHODS
  Between October 1994 to April 2008, 59 patients who had complete macroscopic cytoreduction after EPP formed the basis of this report. In recent years, selected patients received adjuvant radiotherapy and pemetrexed combined with cisplatin or carboplatin. The clinicopathologic data of all patients were prospectively collected in a computerized database. Statistical analysis was performed by using Kaplan-Meier method and compared using the log-rank test. Cox-regression model was used for multivariate analysis.
  
  
  RESULTS
  The mean age at the time of EPP was 59 (S.D. = 8) years. Nineteen patients (32%) experienced perioperative complications. The median survival was 21 months (range 2 to 104). The local disease recurrence rate was 51%. The median local DFS was 22 months (0 to 73). The overall disease recurrence rate was 64%. The median overall DFS was 18 months (range 0 to 73). In multivariate analysis, epithelial subtype (p = 0.026) and adjuvant radiotherapy (p = 0.023) were independently associated with an improved local DFS. Adjuvant radiotherapy (p = 0.011) was also independently associated with an improved overall DFS.
  
  
  CONCLUSIONS
  This study demonstrated that that local disease failure was still a considerable clinical problem following complete EPP. The data also showed that patients with epithelial histology and receiving adjuvant radiotherapy were associated with an improved disease control.
authors.affiliation: University of Sydney (Drs Yan, McLean, Bannon and McCaughan), Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital; the Baird Institute for Applied Heart and Lung Surgical (Drs Yan, McLean, Bannon and McCaughan), Australia; Department of Medical Oncology (Drs Tin and Boyer), Royal Prince Alfred Hospital; Sydney Cancer Center (Drs Tin and Boyer), Australia; Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.forename: Momo
authors.initials: M
authors.lastname: Tin
authors.forename: Michael
authors.initials: M
authors.lastname: Boyer
authors.forename: Jocelyn
authors.initials: J
authors.lastname: McLean
authors.forename: Paul
authors.initials: P
authors.lastname: G Bannon
authors.forename: Brian C
authors.initials: BC
authors.lastname: McCaughan