title: Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection.
abstract: OBJECTIVE
  Local recurrence limits long-term survival in patients with malignant pleural mesothelioma. We investigated whether hyperthermic intraoperative cisplatin chemotherapy lavage affects the interval to recurrence and overall survival among patients with favorable prognostic factors.
  
  
  METHODS
  Using a preoperative risk assessment algorithm we had previously developed and validated, we retrospectively identified a cohort of patients treated with cytoreductive surgery from 2001 to 2009. The patients had epithelial histologic findings on biopsy and were characterized as having a low risk of early recurrence and death (ie, tumor volume ≤ 500 cm(3) and were either men with a hemoglobin level of ≥ 13 g/dL or were women). Those patients who had received hyperthermic intraoperative cisplatin chemotherapy were compared with a comparison group of those who had not. Fisher's exact test was used to determine the balance of prognostic factors. The Kaplan-Meier method and log-rank tests were used to estimate and compare the interval to recurrence and overall survival. Cox proportional hazards regression was used for multivariate analysis.
  
  
  RESULTS
  The cohort criteria identified 103 patients: 72 who received hyperthermic intraoperative cisplatin chemotherapy and 31 who did not. The groups were balanced for prognostic factors, except for the use of neoadjuvant chemotherapy (more common in the comparison group). The hyperthermic intraoperative cisplatin chemotherapy group exhibited a significantly longer interval to recurrence (27.1 vs 12.8 months) and overall survival (35.3 vs 22.8 months) than the comparison group. The improved interval to recurrence and overall survival for the hyperthermic intraoperative cisplatin chemotherapy group were particularly evident among the subgroups of patients who had not received hemithoracic radiotherapy and who had pathologic stage N1 or N2 lymph node metastases.
  
  
  CONCLUSIONS
  A favorable outcome and minimal incremental morbidity support the incorporation of hyperthermic intraoperative cisplatin chemotherapy into multimodality treatment strategies for patients with low-risk epithelial malignant pleural mesothelioma.
authors: Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. Electronic address: dsugarbaker@partners.org.
authors: David J
authors: DJ
authors: Sugarbaker
authors: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors: Ritu R
authors: RR
authors: Gill
authors: Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors: Beow Y
authors: BY
authors: Yeap
authors: Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors: Andrea S
authors: AS
authors: Wolf
authors: Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors: Marcelo C
authors: MC
authors: DaSilva
authors: Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass.
authors: Elizabeth H
authors: EH
authors: Baldini
authors: Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors: Raphael
authors: R
authors: Bueno
authors: Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors: William G
authors: WG
authors: Richards
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008654:Mesothelioma / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D010997:Pleural Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin