Is less also better? A single-institution experience on treatment of early stage Malignant Pleural Mesothelioma

• Published in: European journal of surgical oncology Vol. 43; no. 7; pp. 1365 - 1371
• Main Authors: Bertoglio, Pietro, Ambrogi, Marcello Carlo, Chella, Antonio, Aprile, Vittorio, Dini, Paolo, Korasidis, Stylianos, Fanucchi, Olivia, Mussi, Alfredo
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2017
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Cisplatin - administration & dosage; Combined Modality Therapy; Doxorubicin - administration & dosage; Early stage; Female; Hematology, Oncology and Palliative Medicine; Humans; Hyperthermia, Induced; Hyperthermic TntraTHOracic Chemotherapy; Length of Stay; Male; Malignant Pleural Mesothelioma; Mesothelioma - pathology; Mesothelioma - therapy; Middle Aged; Neoplasm Staging; Organ Sparing Treatments; Pleural Neoplasms - pathology; Pleural Neoplasms - therapy; Pleurectomy and decortication; Postoperative Complications - etiology; Retrospective Studies; Surgery; Survival Rate; Thoracic Surgical Procedures; Pleurectomy and Decortication; Early stage; Malignant Pleural Mesothelioma; Hyperthermic Intrathoracic Chemotherapy; Pleurectomy and decortication; Hyperthermic TntraTHOracic Chemotherapy
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2017.02.010

Abstract Objectives No clear evidence of which surgical procedure should be performed for early stage mesothelioma is available to date. We analyzed our 10-year experience in the treatment of early stage Mesothelioma with surgery and Hyperthermic Intrathoracic Chemotherapy. Methods We retrospectively analyzed all cases of histologically proven epithelioid or biphasic IMIG stage I and II mesothelioma that we operated between 2005 and 2014. We performed an open pleurectomy and partial decortication of any visible lesion on the visceral pleura in all cases and both diaphragm and pericardium were always spared; Hyperthermic intrathoracic chemotherapy was ran using Cisplatin 80 mg/sqm and Doxorubicin 25 mg/sqm at a target temperature of 42.5°C for 60 minutes. Results We operated on 26 patients (23 male and 3 female); epithelioid tumor was diagnosed in 23 cases. Twelve patients were in IMIG stage I and 14 in IMIG stage II; median overall survival for all patients, stage I and II were 35.6, 46 and 23 months respectively and disease free survival was 18, 18 and 16 months respectively. Our results for stage I were better than those reported in literature and were similar for stage II. We observe no 30- and 90- mortality and the rate of severe complication (CTCAE stage 3) were 30%; the median postoperative stay was 7.5 days. Conclusions Our lung sparing approach for the treatment of Pleural Mesothelioma in early stages allows promising long term outcomes with a complete sparing of pulmonary and diaphragmatic function. Larger studies are needed to confirm our good results.