INTRODUCTION: Treatment of malignant pleural mesothelioma (MPM) remains a clinical challenge. The aim of this study was to identify selection factors for allocation of MPM patients to multimodal therapy based on survival data from 12 years of experience. METHODS: Eligible patients had MPM of all histological subtypes with clinical stage T1-3 N0-2 M0. Induction chemotherapy consisted of cisplatin/gemcitabine (cis/gem) or cisplatin/pemetrexed (cis/pem), followed by extrapleural pneumonectomy (EPP). Multivariate analysis was performed to assess independent prognosticators for overall survival (OS). A Multimodality Prognostic Score was developed based on clinical variables available before surgery. RESULTS: From May 1999 to August 2011, 186 MPM patients were intended to be treated with induction chemotherapy followed by EPP. Hematologic toxicity was significantly less frequent after cis/pem compared to cis/gem, but there was no difference in response or OS between the regimens. One hundred and twenty-eight patients underwent EPP with a 30-day mortality of 4.7%. Fifty-two percent of the patients received adjuvant radiotherapy. The median OS of patients undergoing EPP was significantly longer with 22 months (95% confidence interval: 20-24) when compared to 11 months (9-12) for patients treated without EPP. A prognostic score was defined considering tumor volume, histology, C-reactive protein level, and response to chemotherapy that identified patient groups not benefitting from multimodality treatment which was confirmed in an independent cohort. CONCLUSION: Patients receiving induction chemotherapy followed by EPP for MPM of all histological subtypes and irrespective of nodal status showed a median survival of 22 months. A prognostic score is proposed to help patient allocation for surgery after validation in an independent cohort.
INTRODUCTION: Treatment of malignant pleural mesothelioma (MPM) remains a clinical challenge. The aim of this study was to identify selection factors for allocation of MPM patients to multimodal therapy based on survival data from 12 years of experience. METHODS: Eligible patients had MPM of all histological subtypes with clinical stage T1-3 N0-2 M0. Induction chemotherapy consisted of cisplatin/gemcitabine (cis/gem) or cisplatin/pemetrexed (cis/pem), followed by extrapleural pneumonectomy (EPP). Multivariate analysis was performed to assess independent prognosticators for overall survival (OS). A Multimodality Prognostic Score was developed based on clinical variables available before surgery. RESULTS: From May 1999 to August 2011, 186 MPM patients were intended to be treated with induction chemotherapy followed by EPP. Hematologic toxicity was significantly less frequent after cis/pem compared to cis/gem, but there was no difference in response or OS between the regimens. One hundred and twenty-eight patients underwent EPP with a 30-day mortality of 4.7%. Fifty-two percent of the patients received adjuvant radiotherapy. The median OS of patients undergoing EPP was significantly longer with 22 months (95% confidence interval: 20-24) when compared to 11 months (9-12) for patients treated without EPP. A prognostic score was defined considering tumor volume, histology, C-reactive protein level, and response to chemotherapy that identified patient groups not benefitting from multimodality treatment which was confirmed in an independent cohort. CONCLUSION:Patients receiving induction chemotherapy followed by EPP for MPM of all histological subtypes and irrespective of nodal status showed a median survival of 22 months. A prognostic score is proposed to help patient allocation for surgery after validation in an independent cohort.
Authors: Michele Carbone; Harvey I Pass; Guntulu Ak; H Richard Alexander; Paul Baas; Francine Baumann; Andrew M Blakely; Raphael Bueno; Aleksandra Bzura; Giuseppe Cardillo; Jane E Churpek; Irma Dianzani; Assunta De Rienzo; Mitsuru Emi; Salih Emri; Emanuela Felley-Bosco; Dean A Fennell; Raja M Flores; Federica Grosso; Nicholas K Hayward; Mary Hesdorffer; Chuong D Hoang; Peter A Johansson; Hedy L Kindler; Muaiad Kittaneh; Thomas Krausz; Aaron Mansfield; Muzaffer Metintas; Michael Minaai; Luciano Mutti; Maartje Nielsen; Kenneth O'Byrne; Isabelle Opitz; Sandra Pastorino; Francesca Pentimalli; Marc de Perrot; Antonia Pritchard; Robert Taylor Ripley; Bruce Robinson; Valerie Rusch; Emanuela Taioli; Yasutaka Takinishi; Mika Tanji; Anne S Tsao; A Murat Tuncer; Sebastian Walpole; Andrea Wolf; Haining Yang; Yoshie Yoshikawa; Alicia Zolondick; David S Schrump; Raffit Hassan Journal: J Thorac Oncol Date: 2022-04-21 Impact factor: 20.121
Authors: F Galateau Salle; N Le Stang; A G Nicholson; D Pissaloux; A Churg; S Klebe; V L Roggli; H D Tazelaar; J M Vignaud; R Attanoos; M B Beasley; H Begueret; F Capron; L Chirieac; M C Copin; S Dacic; C Danel; A Foulet-Roge; A Gibbs; S Giusiano-Courcambeck; K Hiroshima; V Hofman; A N Husain; K Kerr; A Marchevsky; K Nabeshima; J M Picquenot; I Rouquette; C Sagan; J L Sauter; F Thivolet; W D Travis; M S Tsao; B Weynand; F Damiola; A Scherpereel; J C Pairon; S Lantuejoul; V Rusch; N Girard Journal: J Thorac Oncol Date: 2018-04-30 Impact factor: 15.609
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Authors: Francoise Galateau Salle; Nolwenn Le Stang; Franck Tirode; Pierre Courtiol; Andrew G Nicholson; Ming-Sound Tsao; Henry D Tazelaar; Andrew Churg; Sanja Dacic; Victor Roggli; Daniel Pissaloux; Charles Maussion; Matahi Moarii; Mary Beth Beasley; Hugues Begueret; David B Chapel; Marie Christine Copin; Allen R Gibbs; Sonja Klebe; Sylvie Lantuejoul; Kazuki Nabeshima; Jean-Michel Vignaud; Richard Attanoos; Luka Brcic; Frederique Capron; Lucian R Chirieac; Francesca Damiola; Ruth Sequeiros; Aurélie Cazes; Diane Damotte; Armelle Foulet; Sophie Giusiano-Courcambeck; Kenzo Hiroshima; Veronique Hofman; Aliya N Husain; Keith Kerr; Alberto Marchevsky; Severine Paindavoine; Jean Michel Picquenot; Isabelle Rouquette; Christine Sagan; Jennifer Sauter; Francoise Thivolet; Marie Brevet; Philippe Rouvier; William D Travis; Gaetane Planchard; Birgit Weynand; Thomas Clozel; Gilles Wainrib; Lynnette Fernandez-Cuesta; Jean-Claude Pairon; Valerie Rusch; Nicolas Girard Journal: J Thorac Oncol Date: 2020-03-09 Impact factor: 15.609
Authors: Samuel G Armato; Kevin G Blyth; Jane J Keating; Sharyn Katz; Selina Tsim; Johan Coolen; Eyjolfur Gudmundsson; Isabelle Opitz; Anna K Nowak Journal: Lung Cancer Date: 2016-09-05 Impact factor: 5.705