Lung Cancer. 2007 Jul;57(1):89-95. Epub 2007 Apr 2. [Link]
Rea F, Marulli G, Bortolotti L, Breda C, Favaretto AG, Loreggian L, Sartori F.
Division of Thoracic Surgery, University of Padua, Policlinico di Padova, Italy. firstname.lastname@example.org
Background: Trimodality therapy seems to be the best treatment for malignant pleural mesothelioma (MPM). A large experience served to evaluate the efficacy of surgery followed by adjuvant chemo-radiotherapy. Trimodality therapy results have led us to test induction chemotherapy followed by EPP and adjuvant radiotherapy in stages Iâ€“III of MPM. The aim of our study was to evaluate the feasibility of this protocol and to estimate survival.
Methods: From 2000 to 2003, 21 patients with MPM (14 males and 7 females, median age 59 years) were enrolled in the prospective study. Induction chemotherapy consisted of Carboplatin (AUC 5mg/mL/min on Day 1) and Gemcitabine (1000mg/m2 on Days 1, 8, 15) for three to four cycles. EPP was performed 3â€“5 weeks after induction therapy, while post-operative RT was given 4â€“6 weeks after operation.
Results: Ten patients received three cycles of chemotherapy, 10 patients received four cycles and 1 patient had two cycles. Grades 3â€“4 haematological toxicity occurred in eight (38.1%) patients. Chemotherapy response rate was: complete 0%, partial 33.3% and stable disease 66.7%. Seventeen (80.9%) out of 21 patients underwent EPP with no intra or post-operative mortality with an overall major and minor morbidity rate at 52.4%. Median survival was 25.5 months, with an overall 1, 3 and 5-year survival rate of 71, 33 and 19%, respectively.
Conclusions: In MPM, the combined modality approach using the Carboplatin/Gemcitabine combination as induction chemotherapy is feasible, with good results in terms of survival and morbidity. Our results are similar to those of other studies using a heavier modality treatment.
Keywords: Malignant pleural mesothelioma, Induction chemotherapy, Radiation therapy, Surgery