title: Is less also better? A single-institution experience on treatment of early stage Malignant Pleural Mesothelioma.
abstract: OBJECTIVE
  No clear evidence of which surgical procedure should be performed for early stage mesothelioma is available to date. We analyzed our 10-year experience in the treatment of early stage mesothelioma with surgery and Hyperthermic IntraTHOracic Chemotherapy.
  
  
  METHODS
  We retrospectively analyzed all cases of histologically proven epithelioid or biphasic IMIG stage I and II mesothelioma that we operated between 2005 and 2014. We performed an open pleurectomy and partial decortication of any visible lesion on the visceral pleura in all cases and both diaphragm and pericardium were always spared; Hyperthermic IntraTHOracic Chemotherapy was ran using Cisplatin 80 mg/m2and Doxorubicin 25 mg/m2at a target temperature of 42.5 °C for 60 min.
  
  
  RESULTS
  We operated on 26 patients (23 male and 3 female); epithelioid tumor was diagnosed in 23 cases. Twelve patients were in IMIG stage I and 14 in IMIG stage II; median overall survival for all patients, stage I and II were 35.6, 46 and 23 months respectively and disease free survival was 18, 18 and 16 months respectively. Our results for stage I were better than those reported in literature and were similar for stage II. We observe no 30- and 90- mortality and the rate of severe complication (all CTCAE stage 3) were 30%; the median postoperative stay was 7.5 days.
  
  
  CONCLUSIONS
  Our lung sparing approach for the treatment of pleural mesothelioma in early stages allows promising long term outcomes with a complete sparing of pulmonary and diaphragmatic function. Larger studies are needed to confirm our good results.
authors.affiliation: Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy. Electronic address: pieberto@hotmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Bertoglio
authors.affiliation: Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Ambrogi
authors.affiliation: Division of Pneumology, Cardio Thoracic and Vascular Department, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Chella
authors.affiliation: Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Aprile
authors.affiliation: Division of Thoracic Surgery, Cardio Thoracic and Vascular Department, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Dini
authors.affiliation: Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Korasidis
authors.affiliation: Division of Thoracic Surgery, Cardio Thoracic and Vascular Department, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Fanucchi
authors.affiliation: Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mussi
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007902:Length of Stay; D008297:Male; D008654:Mesothelioma / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D010997:Pleural Neoplasms / Q000473:pathology / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D019616:Thoracic Surgical Procedures
chemical_list: D004317:Doxorubicin; D002945:Cisplatin
keywords: Early stage; Hyperthermic TntraTHOracic Chemotherapy; Malignant Pleural Mesothelioma; Pleurectomy and decortication