Additional chemotherapy is often not feasible in patients with recurrent malignant pleural mesothelioma (MPM) undergoing extrapleural pneumonectomy (EPP), due to deteriorated cardiopulmonary reserve. We thus examined the feasibility and efficacy of additional chemotherapy in patients with recurrent MPM after EPP.
A retrospective review was conducted of 59 consecutive patients who underwent bi-/tri-modal treatment with induction chemotherapy, EPP, and radiation therapy from July 2004 to August 2013 at Hyogo College of Medicine (Nishinomiya, Japan).
Of 59 patients, 39 (male/female = 31/8, right/left = 15/24, pathological stage I/II/III/IV = 1/7/23/3, bi-/tri-modality = 27/12) relapsed at a median age of 62 (range 37–71) years. The median time to recurrence after EPP was 11.6 months. Of the 39 relapsed patients, 12 received best supportive care alone, six started but discontinued chemotherapy, and the remaining 21 (53%) completed more than three cycles of intravenous chemotherapy. The median survival time after EPP was significantly longer in 21 patients who received additional chemotherapy than in 18 patients who did not (39.2 vs. 12.2 months, P = 0.009).
Additional systemic chemotherapy was successfully administered in more than 50% of relapsed patients after bi-/tri-modal treatment, which included EPP, and resulted in a longer survival in comparison with best supportive care alone.
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Rice D, Rusch V, Pass H et al. (2011) Recommendations for uniform definitions of surgical techniques for malignant pleural mesothelioma: a consensus report of the international association for the study of lung cancer international staging committee and the international mesothelioma interest group. J Thorac Oncol 6(8):1304–1312. doi:10.1097/JTO.0b013e3182208e3f
Lang-Lazdunski L, Bille A, Lal R et al. (2012) Pleurectomy/decortication is superior to extrapleural pneumonectomy in the multimodality management of patients with malignant pleural mesothelioma. J Thorac Oncol 7(4):737–743. doi:10.1097/JTO.0b013e31824ab6c5
Cao C, Tian D, Park J et al. (2014) A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma. Lung Cancer 83(2):240–245. doi:10.1016/j.lungcan.2013.11.026
Lang-Lazdunski L (2014) Surgery for malignant pleural mesothelioma: why, when and what? Lung Cancer 84(2):103–109. doi:10.1016/j.lungcan.2014.01.021
Rena O, Casadio C (2012) Extrapleural pneumonectomy for early stage malignant pleural mesothelioma: an harmful procedure. Lung Cancer. doi:10.1016/j.lungcan.2011.12.009
de Perrot M, Feld R, Cho BC et al. (2009) Trimodality therapy with induction chemotherapy followed by extrapleural pneumonectomy and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Clin Oncol 27(9):1413–1418. doi:10.1200/JCO.2008.17.5604
Jassem J, Ramlau R, Santoro A et al. (2008) Phase III trial of pemetrexed plus best supportive care compared with best supportive care in previously treated patients with advanced malignant pleural mesothelioma. J Clin Oncol 26(10):1698–1704. doi:10.1200/jco.2006.09.9887
Baldini EH, Recht A, Strauss GM et al. (1997) Patterns of failure after trimodality therapy for malignant pleural mesothelioma. Ann Thorac Surg 63(2):334–338
Hasegawa S (2014) Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma. Gen Thorac Cardiovasc Surg. doi:10.1007/s11748-014-0389-7
Treasure T, Lang-Lazdunski L, Waller D et al. (2011) Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study. Lancet Oncol 12(8):763–772. doi:10.1016/s1470-2045(11)70149-8
Hasegawa S, Okada M, Tanaka F et al. (2015) Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial). Int J Clin Oncol. doi:10.1007/s10147-015-0925-1
Bolukbas S, Manegold C, Eberlein M et al. (2011) Survival after trimodality therapy for malignant pleural mesothelioma: radical pleurectomy, chemotherapy with cisplatin/pemetrexed and radiotherapy. Lung Cancer 71(1):75–81. doi:10.1016/j.lungcan.2009.08.019
Gomez DR, Hong DS, Allen PK et al. (2013) Patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesothelioma. J Thorac Oncol 8(2):238–245. doi:10.1097/JTO.0b013e31827740f0
Vogelzang NJ, Rusthoven JJ, Symanowski J et al. (2003) Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 21(14):2636–2644. doi:10.1200/JCO.2003.11.136
Manegold C, Symanowski J, Gatzemeier U et al. (2005) Second-line (post-study) chemotherapy received by patients treated in the phase III trial of pemetrexed plus cisplatin versus cisplatin alone in malignant pleural mesothelioma. Ann Oncol 16(6):923–927. doi:10.1093/annonc/mdi187
Gerbaudo VH, Mamede M, Trotman-Dickenson B et al. (2011) FDG PET/CT patterns of treatment failure of malignant pleural mesothelioma: relationship to histologic type, treatment algorithm, and survival. Eur J Nucl Med Mol Imaging 38(5):810–821. doi:10.1007/s00259-010-1704-x
Kostron A, Friess M, Crameri O et al. (2015) Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesotheliomadagger. Eur J Cardiothorac Surg. doi:10.1093/ejcts/ezv398
The authors would like to thank Enago (www.enago.jp) for the English language review.
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All authors have declared no conflicts of interest.
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Takuwa, T., Hashimoto, M., Matsumoto, S. et al. Post-recurrence chemotherapy for mesothelioma patients undergoing extrapleural pneumonectomy. Int J Clin Oncol 22, 857–864 (2017). https://doi.org/10.1007/s10147-017-1126-x
- Extrapleural pneumonectomy
- Malignant pleural mesothelioma
- Post-recurrence chemotherapy
- Radiation therapy
- Best supportive care