gms | German Medical Science

Introduction: To investigate the overall survival and time to recurrence after induction chemotherapy followed by extrapleural pneumonectomy for patients with malignant pleural mesothelioma (MPM).

Materials and methods: Eligible patients had MPM with clinical stage T1-3 N0-2 M0 disease considered to be completely resectable. Neoadjuvant chemotherapy consisted of a combination of cisplatin + gemcitabine (cis/gem) or cisplatin + pemetrexed (cis/pem). Surgery included a complete extrapleural pneumonectomy with resection of pericardium and diaphragm. Postoperative radiotherapy was optional for all patients.

Results: From May 1999 to april 2006, 101 patients were intended to treat in the multimodality treatment concept for MPM. 72 patients underwent extrapleural pneumonectomy after induction chemotherapy with cis/gem (65%) or cis/pem. Toxicity was less frequent in the cis/pem group. 26 patients were not resected because progressive disease after chemotherapy. Perioperative or 30-day mortality was 4%. 54 patients (75%) were treated with radiotherapy postoperatively. The median survival of the operated patients was 23 months (95% CI: 18.9-27.1) for a median follow-up time of 18 months (2.8-73.5), median time to recurrence was 15 months (95% CI: 9.7-20.2). There was a trend for a longer survival in the cis/pem group. Significant prognostic factor for longer survival were the EORTC-Score (<1.12 vs >1.12) p=0.02, the histological subtype (epithelial vs. non-epithelial) p=0.004, but not the nodal status (N0 + N1 vs. N2) p=1.08. The time to recurrence was prognostically influenced by the following factors: extend of resection (R0 vs. R1+R2) p=0.05 and the chemotherapy applied (cis/pem vs. cis/gem) p=0.0003.

Discussion: Extrapleural pneumonectomy after neoadjuvant chemotherapy can be performed with a low mortality. Median survival time is 23 months and confirms our previous results with 19 patients. The results after chemotherapy with cis/pem are promising but further data is needed.