Extended Pleurectomy-Decortication-Based Treatment for Advanced Stage Epithelial Mesothelioma Yielding a Median Survival of Nearly Three Years.
BACKGROUND
The purpose of this study was to assess survival for patients with malignant pleural mesothelioma (MPM), epithelial subtype, utilizing extended pleurectomy-decortication combined with intraoperative photodynamic therapy (PDT) and adjuvant pemetrexed-based chemotherapy.


METHODS
From 2005 to 2013, 90 patients underwent lung-sparing surgery and PDT for MPM. All patients had a preoperative diagnosis of epithelial subtype, of which 17 proved to be of mixed histology. The remaining 73 patients with pure epithelial subtype were analyzed. All patients received lung-sparing surgery and PDT; 92% also received chemotherapy. The median follow-up was 5.3 years for living patients.


RESULTS
Macroscopic complete resection was achieved in all 73 patients. Thirty-day mortality was 3% and 90-day mortality was 4%. For all 73 patients (89% American Joint Commission on Cancer stage III/IV, 69% N2 disease, median tumor volume 550 mL), the median overall and disease-free survivals were 3 years and 1.2 years, respectively. For the 19 patients without lymph node metastases (74% stage III/IV, median tumor volume 325 mL), the median overall and disease-free survivals were 7.3 years and 2.3 years, respectively.


CONCLUSIONS
This is a mature dataset for MPM that demonstrates the ability to safely execute a complex treatment plan that included a surgical technique that consistently permitted achieving a macroscopic complete resection while preserving the lung. The role for lung-sparing surgery is unclear but this series demonstrates that it is an option, even for advanced cases. The overall survival of 7.3 years for the node negative subset of patients, still of advanced stage, is encouraging. Of particular interest is the overall survival being approximately triple the disease-free survival, perhaps PDT related. The impact of PDT is unclear, but it is hoped that it will be established by an ongoing randomized trial.
Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland. Electronic address: jfriedberg@smail.umaryland.edu.
Joseph S
JS
Friedberg
Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Charles B
CB
Simone
Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland.
Melissa J
MJ
Culligan
Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Andrew R
AR
Barsky
Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Abigail
A
Doucette
Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Sally
S
McNulty
Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
Stephen M
SM
Hahn
Department of Hematology-Oncology, Penn-Presbyterian Medical Center, Philadelphia, Pennsylvania.
Evan
E
Alley
Department of Pulmonary and Critical Care Medicine, New York University, New York, New York.
Daniel H
DH
Sterman
Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Eli
E
Glatstein
Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Keith A
KA
Cengel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008654:Mesothelioma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D009367:Neoplasm Staging; D000068437:Pemetrexed / Q000627:therapeutic use; D010778:Photochemotherapy; D010997:Pleural Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D000068437:Pemetrexed