Induction chemotherapy, extrapleural pneumonectomy (EPP) and adjuvant hemi-thoracic radiation in malignant pleural mesothelioma (MPM): Feasibility and results

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.


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 I–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 3–5 weeks after induction therapy, while post-operative RT was given 4–6 weeks after operation.

Results: Ten patients received three cycles of chemotherapy, 10 patients received four cycles and 1 patient had two cycles. Grades 3–4 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