Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine, prophylactic radiotherapy, and systemic chemotherapy in patients with malignant pleural mesothelioma: a 10-year experience.
OBJECTIVE
We evaluated the long-term results of pleurectomy/decortication (P/D), hyperthermic pleural lavage with povidone-iodine, prophylactic chest wall radiotherapy (21 Gy), and systemic chemotherapy in patients with malignant pleural mesothelioma.


METHODS
A cohort of patients having surgery between January 2004 and December 2013 were retrospectively studied. All patients received prophylactic radiotherapy postoperatively and all were supposed to receive systemic chemotherapy, either preoperatively or as adjuvant therapy. Patients were reviewed at 30 days, then followed up 6-monthly. (18)F-FDG-PET-CT was used routinely to diagnose disease recurrence. Second-line therapies were administered when appropriate. Survival and prognostic factors were analyzed by the Kaplan-Meier method, log-rank test, and Cox regression analysis.


RESULTS
One hundred two patients had P/D followed by prophylactic radiotherapy and were referred for adjuvant chemotherapy. Median age at operation was 64 years. Eighty-one patients (79.4%) were male; 57 patients (55.9%) had complete macroscopic resection. Thirty-day mortality was nil and 30 patients (29.4%) experienced postoperative complications. Seventy-three patients had epithelioid mesothelioma (71.5%). Sixty-eight patients (66.6%) had N0 disease. Ninety-six patients (94.1%) received the planned 4 to 6 chemotherapy cycles. At last follow-up, 49 patients were alive. Univariate analysis showed no significant difference when sex, age >70 years, nodal status, or prior chemotherapy were considered. The overall median survival was 32 months and 5-year survival rate was 23.1%. Median survival and 5-year survival rates were 35.0 months and 30.7% for epithelioid mesothelioma and 15 months and 7% for nonepithelioid mesothelioma, respectively (P = .0001). Median survival was 45.0 months for R0-R1 resection versus 17.4 months for R2 resection (P = .0001).


CONCLUSIONS
P/D, hyperthermic pleural lavage with povidone-iodine, prophylactic chest wall radiotherapy, and systemic chemotherapy is a safe and well-tolerated multimodality therapy.
Department of Thoracic Surgery, Guy's & St Thomas Hospital, London, United Kingdom; Division of Cancer Studies, King's College London, London, United Kingdom. Electronic address: loic.lang-lazdunski@gstt.nhs.uk.
Loïc
L
Lang-Lazdunski
Department of Thoracic Surgery, Guy's & St Thomas Hospital, London, United Kingdom.
Andrea
A
Bille
Department of Oncology, Guy's & St Thomas Hospital, London, United Kingdom.
Sophie
S
Papa
Department of Thoracic Surgery, Guy's & St Thomas Hospital, London, United Kingdom.
Stuart
S
Marshall
Department of Oncology, Guy's & St Thomas Hospital, London, United Kingdom.
Rohit
R
Lal
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Carlotta
C
Galeone
Department of Oncology, Guy's & St Thomas Hospital, London, United Kingdom.
David
D
Landau
Department of Medical Oncology, Lung and Mesothelioma Unit, St Bartholomew's Hospital, London, United Kingdom.
Jeremy
J
Steele
Department of Oncology, Guy's & St Thomas Hospital, London, United Kingdom; Division of Cancer Studies, King's College London, London, United Kingdom.
James
J
Spicer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D008654:Mesothelioma / Q000628:therapy*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D010997:Pleural Neoplasms / Q000628:therapy*; D011013:Pneumonectomy / Q000379:methods*; D049268:Positron-Emission Tomography; D011206:Povidone-Iodine / Q000627:therapeutic use*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D007507:Therapeutic Irrigation / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D011206:Povidone-Iodine