Joseph S Friedberg1, Charles B Simone2, Melissa J Culligan3, Andrew R Barsky2, Abigail Doucette2, Sally McNulty2, Stephen M Hahn4, Evan Alley5, Daniel H Sterman6, Eli Glatstein2, Keith A Cengel2. 1. Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland. Electronic address: jfriedberg@smail.umaryland.edu. 2. Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 3. Division of Thoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland. 4. Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas. 5. Department of Hematology-Oncology, Penn-Presbyterian Medical Center, Philadelphia, Pennsylvania. 6. Department of Pulmonary and Critical Care Medicine, New York University, New York, New York.
Abstract
BACKGROUND: The purpose of this study was to assess survival for patients with malignant pleural mesothelioma (MPM), epithelial subtype, utilizing extended pleurectomy-decortication combined with intraoperative photodynamic therapy (PDT) and adjuvant pemetrexed-based chemotherapy. METHODS: From 2005 to 2013, 90 patients underwent lung-sparing surgery and PDT for MPM. All patients had a preoperative diagnosis of epithelial subtype, of which 17 proved to be of mixed histology. The remaining 73 patients with pure epithelial subtype were analyzed. All patients received lung-sparing surgery and PDT; 92% also received chemotherapy. The median follow-up was 5.3 years for living patients. RESULTS: Macroscopic complete resection was achieved in all 73 patients. Thirty-day mortality was 3% and 90-day mortality was 4%. For all 73 patients (89% American Joint Commission on Cancer stage III/IV, 69% N2 disease, median tumor volume 550 mL), the median overall and disease-free survivals were 3 years and 1.2 years, respectively. For the 19 patients without lymph node metastases (74% stage III/IV, median tumor volume 325 mL), the median overall and disease-free survivals were 7.3 years and 2.3 years, respectively. CONCLUSIONS: This is a mature dataset for MPM that demonstrates the ability to safely execute a complex treatment plan that included a surgical technique that consistently permitted achieving a macroscopic complete resection while preserving the lung. The role for lung-sparing surgery is unclear but this series demonstrates that it is an option, even for advanced cases. The overall survival of 7.3 years for the node negative subset of patients, still of advanced stage, is encouraging. Of particular interest is the overall survival being approximately triple the disease-free survival, perhaps PDT related. The impact of PDT is unclear, but it is hoped that it will be established by an ongoing randomized trial.
BACKGROUND: The purpose of this study was to assess survival for patients with malignant pleural mesothelioma (MPM), epithelial subtype, utilizing extended pleurectomy-decortication combined with intraoperative photodynamic therapy (PDT) and adjuvant pemetrexed-based chemotherapy. METHODS: From 2005 to 2013, 90 patients underwent lung-sparing surgery and PDT for MPM. All patients had a preoperative diagnosis of epithelial subtype, of which 17 proved to be of mixed histology. The remaining 73 patients with pure epithelial subtype were analyzed. All patients received lung-sparing surgery and PDT; 92% also received chemotherapy. The median follow-up was 5.3 years for living patients. RESULTS: Macroscopic complete resection was achieved in all 73 patients. Thirty-day mortality was 3% and 90-day mortality was 4%. For all 73 patients (89% American Joint Commission on Cancer stage III/IV, 69% N2 disease, median tumor volume 550 mL), the median overall and disease-free survivals were 3 years and 1.2 years, respectively. For the 19 patients without lymph node metastases (74% stage III/IV, median tumor volume 325 mL), the median overall and disease-free survivals were 7.3 years and 2.3 years, respectively. CONCLUSIONS: This is a mature dataset for MPM that demonstrates the ability to safely execute a complex treatment plan that included a surgical technique that consistently permitted achieving a macroscopic complete resection while preserving the lung. The role for lung-sparing surgery is unclear but this series demonstrates that it is an option, even for advanced cases. The overall survival of 7.3 years for the node negative subset of patients, still of advanced stage, is encouraging. Of particular interest is the overall survival being approximately triple the disease-free survival, perhaps PDT related. The impact of PDT is unclear, but it is hoped that it will be established by an ongoing randomized trial.
Authors: Raja M Flores; Tom Routledge; Venkatraman E Seshan; Joseph Dycoco; Maureen Zakowski; Yael Hirth; Valerie W Rusch Journal: J Thorac Cardiovasc Surg Date: 2008-06-27 Impact factor: 5.209
Authors: David J Sugarbaker; Ritu R Gill; Beow Y Yeap; Andrea S Wolf; Marcelo C DaSilva; Elizabeth H Baldini; Raphael Bueno; William G Richards Journal: J Thorac Cardiovasc Surg Date: 2013-02-21 Impact factor: 5.209
Authors: Joseph S Friedberg; Rosemarie Mick; Melissa Culligan; James Stevenson; Annemarie Fernandes; Deborah Smith; Eli Glatstein; Stephen M Hahn; Keith Cengel Journal: Ann Thorac Surg Date: 2011-06 Impact factor: 4.330
Authors: Joseph S Friedberg; Melissa J Culligan; Rosemarie Mick; James Stevenson; Stephen M Hahn; Daniel Sterman; Salman Punekar; Eli Glatstein; Keith Cengel Journal: Ann Thorac Surg Date: 2012-05 Impact factor: 4.330
Authors: Marc de Perrot; Ronald Feld; Natasha B Leighl; Andrew Hope; Thomas K Waddell; Shaf Keshavjee; B C John Cho Journal: J Thorac Cardiovasc Surg Date: 2015-10-19 Impact factor: 5.209
Authors: Aliya N Husain; Thomas V Colby; Nelson G Ordóñez; Thomas Krausz; Alain Borczuk; Philip T Cagle; Lucian R Chirieac; Andrew Churg; Francoise Galateau-Salle; Allen R Gibbs; Allen M Gown; Samuel P Hammar; Leslie A Litzky; Victor L Roggli; William D Travis; Mark R Wick Journal: Arch Pathol Lab Med Date: 2009-08 Impact factor: 5.534
Authors: Tom Treasure; Loic Lang-Lazdunski; David Waller; Judith M Bliss; Carol Tan; James Entwisle; Michael Snee; Mary O'Brien; Gill Thomas; Suresh Senan; Ken O'Byrne; Lucy S Kilburn; James Spicer; David Landau; John Edwards; Gill Coombes; Liz Darlison; Julian Peto Journal: Lancet Oncol Date: 2011-06-30 Impact factor: 41.316
Authors: Loïc Lang-Lazdunski; Andrea Bille; Sophie Papa; Stuart Marshall; Rohit Lal; Carlotta Galeone; David Landau; Jeremy Steele; James Spicer Journal: J Thorac Cardiovasc Surg Date: 2014-10-14 Impact factor: 5.209
Authors: Timothy C Zhu; Yihong Ong; Michele M Kim; Xing Liang; Jarod C Finlay; Andreea Dimofte; Charles B Simone; Joseph S Friedberg; Theresa M Busch; Eli Glatstein; Keith A Cengel Journal: Photochem Photobiol Date: 2019-10-22 Impact factor: 3.421
Authors: Richard W Davis; Emma Snyder; Joann Miller; Shirron Carter; Cassandra Houser; Astero Klampatsa; Steven M Albelda; Keith A Cengel; Theresa M Busch Journal: Photochem Photobiol Date: 2018-11-26 Impact factor: 3.421
Authors: Stephanie R Rice; Yun R Li; Theresa M Busch; Michele M Kim; Sally McNulty; Andrea Dimofte; Timothy C Zhu; Keith A Cengel; Charles B Simone Journal: Photochem Photobiol Date: 2018-12-28 Impact factor: 3.421