J. H. Schouwink, L. Schultze Kool, E. J. Rutgers, F. A. N. Zoetmulder, N. van Zandwijk, M. J. v.d. Vijver, and P. Baas
The value of chest computer tomography and cervical mediastinoscopy in the preoperative assessment of patients with malignant pleural mesothelioma
Ann. Thorac. Surg., June 1, 2003; 75(6): 1715 - 1718.
[Abstract] (see below) [Full Text] [PDF]

The value of chest computer tomography and cervical mediastinoscopy in the preoperative assessment of patients with malignant pleural mesothelioma

J. Hugo Schouwink, MD^a,e*, Leo Schultze Kool, MD, PhD^b, Emiel J. Rutgers, MD, PhD^c, Frans A. N. Zoetmulder, MD, PhD^c, Nico van Zandwijk, MD, PhD^a, Marc J. v.d. Vijver, MD, PhD^d, Paul Baas, MD, PhD^a

^a Department of Thoracic Oncology, Amsterdam, The Netherlands
^b Department ofRadiology, Amsterdam, The Netherlands
^c Department ofSurgical Oncology, Amsterdam, The Netherlands
^d Department ofPathology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
^e Department of Pulmonology, Medisch Spectrum Twente, Enschede, The Netherlands

Accepted for publication December 22, 2002.

^* Address reprint requests to Dr Schouwink, Medisch Spectrum Twente, Department of Pulmonary Diseases, Postbus 50000, Enschede 7500 KA, The Netherlands
e-mail: j.schouwink@ziekenhuis-mst.nl

BACKGROUND: Patients with localized malignant pleural mesothelioma (MPM) can be considered for surgical resection with or without additional treatment. For this approach it is imperative to select patients without mediastinal lymph node involvement. In this study cervical mediastinoscopy (CM) is compared with computer tomography (CT) scanning for its diagnostic accuracy in assessing mediastinal lymph nodes during preoperative workup.

METHODS: Computer tomography scans of the chest and CM were performed in 43 patients with proven unilateral MPM. The CT scans were reviewed by one radiologist and two chest physicians. At CM the lymph node samples were taken from stations Naruke 2, 3, 4, and 7. Computer tomography and CM results were compared with final histopathologic findings obtained at thoracotomy or, if this was not performed, at CM.

RESULTS: Computer tomography scanning revealed pathologic enlarged lymph nodes with a shortest diameter of at least 10 mm in 17 of 43 patients (39%). There was histopathologic evidence of lymph node metastases at CM in 11 of these patients (26%). This resulted in a sensitivity of 60% and 80%, a specificity of 71% and 100%, and a diagnostic accuracy of 67% and 93% for CT and CM, respectively.

CONCLUSIONS: Cervical mediastinoscopy is a valuable diagnostic procedure for patients with MPM who are considered candidates for surgical-based therapy. Results of CM are more reliable than those obtained by CT scanning. Our data confirm results of previous studies reporting that mediastinal lymph node involvement is a frequent event in MPM

W.R. Smythe and P.F. Mansfield
Hyperthermia: Has Its Time Come?
Ann. Surg. Oncol., April 1, 2003; 10(3): 210 - 212.
[Full Text] [PDF]

S. van Ruth, P. Baas, R.L. M. Haas, E.J. Th. Rutgers, V.J. Verwaal, and F.A. N. Zoetmulder
Cytoreductive Surgery Combined With Intraoperative Hyperthermic Intrathoracic Chemotherapy for Stage I Malignant Pleural Mesothelioma
Ann. Surg. Oncol., March 1, 2003; 10(2): 176 - 182.
[Abstract ](see below)  [Full Text] [PDF]

Cytoreductive Surgery Combined With Intraoperative Hyperthermic Intrathoracic Chemotherapy for Stage I Malignant Pleural Mesothelioma

S. van Ruth, MD, P. Baas, MD, PhD, R.L. M. Haas, MD, PhD, E.J. Th. Rutgers, MD, PhD, V.J. Verwaal, MD and F.A. N. Zoetmulder, MD, PhD

From the Departments of Surgical Oncology (SvR, EJTR, VJV, FANZ), Thoracic Oncology (PB), and Radiotherapy (RLMH), The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.

Correspondence: Address correspondence and reprint requests to: S. van Ruth, MD, Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Fax: 31-20-5122554; E-mail: s.v.ruth@nki.nl.

Background: Malignant pleural mesothelioma (MPM) is a disease mostly confined to the thoracic cavity. Untreated, the median survival is <1 year. Cytoreductive surgery combined with intraoperative hyperthermic intrathoracic chemotherapy is used to kill residual tumor cells on the surface of the thoracic cavity while having limited systemic side effects.

Methods: From August 1998 to August 2001, 22 patients with stage I MPM were included in this study. Two patients were irresectable at operation because of extrathoracic tumor growth. Twenty procedures were performed. After cytoreduction, a perfusion was performed with cisplatin and doxorubicin at 40°C to 41°C for 90 minutes. Adjuvant radiotherapy was given to surgical scars and drainage tracts.

Results: There was no perioperative mortality, but significant morbidity was seen in 13 patients (65%), including bronchopleural fistula, diaphragm rupture, wound dehiscence, persistent air leakage, and chylous effusion. No hair loss or leucopenia was noticed. The median follow-up was 14 months. The median survival (Kaplan-Meier) was 11 months, with a 1-year survival of 42%. A favorable pharmacokinetic ratio was observed for both cisplatin and doxorubicin.

Conclusions: Cytoreductive surgery combined with hyperthermic intrathoracic chemotherapy for stage I MPM is feasible. However, this treatment is accompanied by considerable morbidity. Survival data were less encouraging.

S. van Ruth, P. Baas, and F. A. N. Zoetmulder
Surgical Treatment of Malignant Pleural Mesothelioma: A Review
Chest, February 1, 2003; 123(2): 551 - 561.
[Abstract] (see below) [Full Text] [PDF]

Surgical Treatment of Malignant Pleural Mesothelioma^*

A Review

Serge van Ruth, MD; Paul Baas, MD, PhD, FCCP and Frans A. N. Zoetmulder, MD, PhD

^* From the Department of Surgical Oncology (Drs. van Ruth and Zoetmulder) and Thoracic Oncology (Dr. Baas), The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.

Correspondence to: Serge van Ruth, MD, Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; e-mail: s.v.ruth@nki.nl

Despite many years of clinical research, there is still no effective therapy for malignant pleural mesothelioma (MPM). Untreated, the prognosis is poor, with a median survival of < 1 year. Single-agent or combination chemotherapy as well as radiotherapy have not shown persistent improvements in response or survival. In general, MPM is a disease confined to the pleural cavity for a long time before metastasizing. Therefore, focus on local treatment seems rational. Surgical resection has been considered the mainstay of treatment by some. However, surgery alone results in high recurrence rates, and the survival benefit remains questionable. In recent years, the emphasis has been on surgery combined with adjuvant therapies. In this article, the present state of surgical management of MPM will be reviewed.

E. de Bree, S. van Ruth, P. Baas, E. J. Th. Rutgers, N. van Zandwijk, A. J. Witkamp, and F. A. N. Zoetmulder
Cytoreductive Surgery and Intraoperative Hyperthermic Intrathoracic Chemotherapy in Patients With Malignant Pleural Mesothelioma or Pleural Metastases of Thymoma
Chest, February 1, 2002; 121(2): 480 - 487.
[Abstract] (see below) [Full Text] [PDF]

Cytoreductive Surgery and Intraoperative Hyperthermic Intrathoracic Chemotherapy in Patients With Malignant Pleural Mesothelioma or Pleural Metastases of Thymoma^*

Eelco de Bree, MD; Serge van Ruth, MD; Paul Baas, MD, PhD; Emiel J. Th. Rutgers, MD, PhD; Nico van Zandwijk, MD, PhD, FCCP; Arjen J. Witkamp, MD and Frans A. N. Zoetmulder, MD, PhD

^* From the Departments of Surgical Oncology (Drs. de Bree, van Ruth, Rutgers, Witkamp, and Zoetmulder) and Thoracic Oncology (Drs. Baas and van Zandwick), the Netherlands Cancer Institute, Amsterdam, the Netherlands.

Correspondence to: Frans A. N. Zoetmulder, MD, PhD, Department of Surgical Oncology, the Netherlands Cancer Institute, (Antoni van Leeuwenhoek Huis), Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; e-mail: fzoet@nki.nl

Study objectives: No established curative treatment is available for pleural thymoma metastases and malignant pleural mesothelioma (MPM). Recently, peritoneal malignancies have been treated by cytoreductive surgery and intraoperative hyperthermic intracavitary perfusion chemotherapy (HIPEC). We investigated the feasibility and safety of this multimodality treatment in the thoracic cavity.

Design: Patients with pleural thymoma metastases or early-stage MPM were enrolled in a feasibility study. Morbidity, recurrence, and survival rates were recorded.

Setting: The Netherlands Cancer Institute.

Patients: Three patients with pleural thymoma metastases and 11 patients with pleural mesothelioma were treated.

Interventions: Cytoreductive surgery and intraoperative hyperthermic intrathoracic perfusion chemotherapy (HITHOC) with cisplatin and adriamycin were performed. The mesothelioma patients received adjuvant radiotherapy on the thoracotomy wound and drainage tracts.

Measurements and results: Morbidity and mortality rates were 47% and 0%, respectively. Reoperation was necessary in four cases. Severe chemotherapy-related complications were not observed. A solitary mediastinal and a contralateral pleural thymoma recurrence were successfully treated by radiotherapy and a contralateral HITHOC procedure. All thymoma patients were alive and free of disease after a mean follow-up period of 18 months. After a mean follow-up period of 7.4 months, nine mesothelioma patients are alive. Two mesothelioma patients died of contralateral pleural and peritoneal recurrent disease, while one patient is alive with locoregional recurrence.

Conclusions: Cytoreductive surgery and HITHOC with cisplatin and adriamycin is feasible in patients with pleural thymoma metastases and early-stage MPM, and is associated with acceptable morbidity rates. Early data on locoregional disease control are encouraging, and a phase II study will be conducted.

H. Schouwink, E. T. Rutgers, J. van der Sijp, H. Oppelaar, N. van Zandwijk, R. van Veen, S. Burgers, F. A. Stewart, F. Zoetmulder, and P. Baas
Intraoperative Photodynamic Therapy After Pleuropneumonectomy in Patients With Malignant Pleural Mesothelioma : Dose Finding and Toxicity Results
Chest, October 1, 2001; 120(4): 1167 - 1174.
[Abstract] (see below) [Full Text] [PDF]

Intraoperative Photodynamic Therapy After Pleuropneumonectomy in Patients With Malignant Pleural Mesothelioma ^: Dose Finding and Toxicity Results

Hugo Schouwink, MD; Emiel T. Rutgers, MD, PhD; Joost van der Sijp, MD, PhD; Hugo Oppelaar, Ing; Nico van Zandwijk, MD, PhD, FCCP; Robert van Veen, Ing; Sjaak Burgers, MD, PhD; Fiona A. Stewart, PhD; Frans Zoetmulder, MD, PhD and Paul Baas, MD, PhD, FCCP

^* From the Departments of Thoracic Oncology (Drs. Schouwink, Van Zandwijk, and Baas), Surgical Oncology (Drs. Rutgers and Zoetmulder), and Experimental Therapy (Dr. Stewart and Mr. Oppelaar), The Netherlands Cancer Institute, Amsterdam, the Netherlands; and the Departments of Thoracic Oncology (Dr. Burgers), Surgical Oncology (Dr. van der Sijp), and Clinical Physics (Mr. van Veen), University Hospital Rotterdam/Daniel, Rotterdam, the Netherlands. Currently at the Department of Pulmonary Diseases, Medisch Spectrum Twente, Enschede, The Netherlands.

Correspondence to: Paul Baas, MD, PhD, FCCP, Department of Thoracic Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; e-mail: p.baas@nki.nl

Objective: To determine the optimal administered dose of meta-tetrahydroxyphenylchlorin (mTHPC) for intraoperative photodynamic therapy (IPDT) in resected malignant pleural mesothelioma (MPM). The primary objective of this combination treatment was to improve local tumor control.

Design: Phase I/II dose escalation study.

Setting: Two Dutch cancer centers.

Patients: The study included 28 patients (2 women, 26 men), with pathologically confirmed MPM. The mean age was 57 years (age range, 37 to 68 years), and the World Health Organization performance score was 0 to 1. Epithelial mesotheliomas were found in 17 patients, a sarcomatous mesothelioma was found in 1 patient, and mixed epithelial sarcomatous mesotheliomas were found in 10 patients.

Methods: Patients were injected with 0.075 mg/kg (4 patients), 0.10 mg/kg (19 patients), or 0.15 mg/kg (5 patients) mTHPC 4 or 6 days before undergoing surgery and IPDT. Complete surgical resection (ie, pleuropneumonectomy) was followed by integral illumination with monochromatic light of 652 nm (10 J/cm²). The real-time fluence rate measurements were performed using four isotropic detectors in the chest cavity to calculate the total light dose.

Results: Dose-limiting toxicity was reached at the level of 0.15 mg/kg mTHPC. Three patients died in the perioperative period, and one death was directly related to photodynamic therapy. Real-time dosimetry identified 12 patients in whom additional illumination had to be given to the diaphragmatic sinuses, which were unavoidably shielded during integral illumination. In two patients, illumination was cancelled due to the insufficient resectability of the tumor. The median survival time for all 28 patients was 10 months. Local tumor control, 9 months after treatment, was achieved in 13 of the 26 patients treated with IPDT.

Conclusion: IPDT using mTHPC, combined with a pleuropneumonectomy, resulted in local control of disease in 50% of the treated cases. The considerable toxicity associated with the procedure, however, precludes its recommendation for widespread use. Stricter patient selection and improvements of the IPDT technique may reduce the toxicity.

V. W. Rusch, K. Rosenzweig, E. Venkatraman, L. Leon, A. Raben, L. Harrison, M. S. Bains, R. J. Downey, and R. J. Ginsberg
A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma
J. Thorac. Cardiovasc. Surg., October 1, 2001; 122(4): 788 - 795.
[Abstract] (see below) [Full Text] [PDF]

A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma

Valerie W. Rusch, MD^a, Kenneth Rosenzweig, MD^b, Ennapadam Venkatraman, PhD^c, Larry Leon, MS^c, Adam Raben, MD^b, Louis Harrison, MD^b, Manjit S. Bains, MD^a, Robert J. Downey, MD^a, Robert J. Ginsberg, MD^a

From the Thoracic Service, Department of Surgery,^a the Department of Radiation Oncology,^b and the Biostatistics Service, Department of Epidemiology and Biostatistics,^c Memorial Sloan-Kettering Cancer Center, New York, NY.

Presented in part at the 2000 Meeting of the American Society of Clinical Oncology.

Received for publication Feb 1, 2001. Revisions requested March 22, 2001; revisions received April 18, 2001. Accepted for publication April 19, 2001. Address for reprints: Valerie W. Rusch, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 (E-mail: ruschv@mskcc.org).

Background: Surgical resection of malignant pleural mesothelioma is reported to have up to an 80% rate of local recurrence. We performed a phase II trial of high-dose hemithoracic radiation after complete resection to determine feasibility and to estimate rates of local recurrence and survival.

Methods: Patients were eligible if they had a resectable tumor, as determined by computed tomographic scanning, and adequate cardiopulmonary function for extrapleural pneumonectomy or pleurectomy/decortication. After complete resection, patients received hemithoracic radiation (54 Gy) and then were followed up with serial computed tomographic scanning.

Results: From 1995 to 1998, 88 patients (73 men and 15 women; median age, 62.5 years) were entered into the study. The operations performed included 62 extrapleural pneumonectomies (70%) and 5 pleurectomies/decortications; procedures for exploration only were performed in 21 patients. Seven (7.9%) patients died postoperatively. Adjuvant radiation administered to 57 patients (54 undergoing extrapleural pneumonectomy and 3 undergoing pleurectomy/decortication) at a median dose of 54 Gy was well tolerated (grade 0-2 fatigue, esophagitis), except for one late esophageal fistula. The median survival was 33.8 months for stage I and II tumors but only 10 months for stage III and IV tumors (P = .04). For the patients undergoing extrapleural pneumonectomy, the sites of recurrence were locoregional in 2, locoregional and distant in 5, and distant only in 30.

Conclusion: Hemithoracic radiation after complete surgical resection at a dose not previously reported is feasible. This approach dramatically reduces local recurrence and is associated with prolonged survival for early-stage tumors. Stage III disease has a high risk of early distant relapse and should be considered for trials of systemic therapy added to this regimen of resection and radiation.

V. W. Rusch and E. Venkatraman
THE IMPORTANCE OF SURGICAL STAGING IN THE TREATMENT OF MALIGNANT PLEURAL MESOTHELIOMA
J. Thorac. Cardiovasc. Surg., April 1, 1996; 111(4): 815 - 826.
[Abstract](see below)  [Full Text]

THE IMPORTANCE OF SURGICAL STAGING IN THE TREATMENT OF MALIGNANT PLEURAL MESOTHELIOMA

Valerie W. Rusch, MD^a, Ennapadam Venkatraman, PhD^b§

Received for publication April 27, 1995 Revisions requested July 17, 1995; revisions received August 7, 1995 Accepted for publication Sept. 15, 1995. Address for reprints: Valerie W. Rusch, MD, Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.

Abstract

Objectives: Progress in the therapy of malignant pleural mesothelioma is limited by the lack of an adequate staging system and controversy about prognostic factors. This surgical series was analyzed to determine whether a new TNM staging system proposed by the International Mesothelioma Interest Group and certain prognostic factors could stratify patients in future clinical trials.

Methods: Thoracotomy was performed if computed tomographic scans showed resectable tumor confined to one hemithorax. Pleurectomy/decortication was done if visceral pleural tumor was minimal, and extrapleural pneumonectomy was done for more locally advanced disease. Complete resection was defined as no gross residual tumor. Adjuvant therapy was given as required by serial clinical trials. Patients had computed tomographic scans every 3 months until death. Prognostic factors were examined by log-rank and Cox regression analyses.

Results: From October 1983 to July 1994, a total of 131 thoracotomies were performed, resulting in 101 resections, 72 of which were complete. Extrapleural pneumonectomy was done in 50 patients and pleurectomy/decortication in 51. The ratio of men to women was 108:23. Median age was 63 years (range 32 to 80 years). Operative mortality was five of 131 patients (3.8%), three of 50 in the group having extrapleural pneumonectomy (6%). Ninety-five of the 131 tumors were epithelial. Fifty-one of 89 patients (57%) having node dissections had diseased nodes, 45 (50%) N2. By univariate analysis, type of resection, T and N status, stage, histologic type, and adjuvant therapy, but not gender or age, significantly affected survival. Type of resection, stage, and histologic type were significant in a multivariate analysis. Local recurrence occurred mainly after pleurectomy/decortication, and distant metastases developed after extrapleural pneumonectomy. Conclusions: (1) N2 nodal disease is more frequent than previously reported; (2) the prognostic importance of histologic type is confirmed; (3) both T and N status influence outcome, and the International Mesothelioma Interest Group staging system successfully identifies patients whose prognosis is poor; (4) despite more locally advanced disease in most patients with extrapleural pneumonectomy, that approach provided better local control than pleurectomy/decortication but failed to improve survival because of distant metastatic disease. Contrary to past practice, future clinical trials should stratify for histologic type, must control for TNM stage, and must consider the impact of type of surgical resection on the pattern of relapse. (J THORAC CARDIOVASC SURG1996;111:815-26)

D. B. Campbell
Malignant Mesothelioma
Ann. Thorac. Surg., May 1, 1997; 63(5): 1503 - 1505.
[Full Text]

M.W. Grossebner, A.A. Arifi, M. Goddard, and A.J. Ritchie
Mesothelioma - VATS biopsy and lung mobilization improves diagnosis and palliation
Eur. J. Cardiothorac. Surg., December 1, 1999; 16(6): 619 - 623.
[Abstract](see below)  [Full Text] [PDF]

Mesothelioma – VATS biopsy and lung mobilization improves diagnosis and palliation

M.W. Grossebner, A.A. Arifi, M. Goddard, A.J. Ritchie

Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, UK

Corresponding author. Tel.: +44-1480-830-541; fax: +44-1480-831-315

Objectives: Mesothelioma is an increasingly frequent malignancy in which diagnosis is often delayed and disease diagnosed at an advanced stage. Earlier diagnosis and therapeutic intervention that can control recurrent pleural effusion may improve outlook and survival.

Methods: A prospective series of 25 patients in whom mesothelioma was suspected was referred for histological diagnosis by video assisted-thoracoscopy (VAT) after failure of other methods. At the same operative procedure drainage of pleural effusion, cytoreductive pleurectomy and lung mobilization was performed where possible. Complete follow-up was obtained.

Results: All patients had a histological diagnosis (100%) from the material sent for biopsy. In 23 patients this was mesothelioma, in two patients chronic empyema. All patients undergoing drainage of effusion, cytoreductive pleurectomy and lung mobilization subsequently were diagnosed of having mesothelioma stages III to IV. Fifteen out of 21 who underwent lung mobilization had closure of the pleural space. Post operative air leak in this group was a mean of 5 days (2–12 days). Recurrent effusion occurred in only one patient. Eleven patients remain alive at 1–2 years post operation with no hospital admissions for recurrent pleural effusion. In the six out of 21 who did not have closure of the pleural space, one remained alive 9 months post surgery. Five died within 1–6 months of the procedure. The average number of further hospital admissions for repeat drainage of effusion was 3 (1–6).

Conclusions: VATs provides adequate tissue for histological diagnosis where other methods fail. At the same operative sitting it provides a therapeutic intervention that allows drainage of effusion cytoreductive pleurectomy and lung mobilization in a significant number of cases. Where the pleural space can be closed this results in significantly fewer hospital admissions and appears to improve quality of life and length of survival. The price is a longer hospital stay due to prolonged air leak.

J. R. Roberts
Surgical Treatment of Mesothelioma: Pleurectomy*
Chest, December 1, 1999; 116(90003): 446S - 449.
[Abstract] (see below) [Full Text]

Surgical Treatment of Mesothelioma: Pleurectomy^*

John R. Roberts, MD, FCCP

^* From Division of General Thoracic Surgery, Department of Cardiac and Thoracic Surgery, Vanderbilt Hospital, Nashville, TN.

Correspondence to: John R. Roberts, MD, FCCP, 2986 The Vanderbilt Clinic, Nashville, TN 37232; e-mail: bob.roberts@mcmail.vanderbilt.edu

Malignant diffuse mesothelioma is the most common type of mesothelioma, with a median survival ranging from 8.5 to 18 months after diagnosis. Good performance status, absence of chest pain, age < 50 years, and epithelial histology are all associated with improved survival. Several investigators have described staging systems for this tumor and have emphasized the importance of thoracoscopy in the diagnosis and staging of the disease. Pleurectomy is the most common surgery employed to manage patients with diffuse mesothelioma, and this procedure is associated with minimal postoperative morbidity and mortality. Because mesothelioma usually recurs locally after surgery, efforts at optimizing local control have included both intraoperative phototherapy and chemotherapy. However, neither of these techniques has demonstrated any significant benefit to date and thus should not be considered as standards of care. No studies have compared pleurectomy to extrapleural pneumonectomy (EPP) in randomized trials. However, nonrandomized series suggest a significant improvement in disease-free survival for those undergoing EPP versus pleurectomy. Other data suggest that EPP may improve local control but may predispose the patient to distant metastases. A randomized comparison of these techniques may be beneficial in identifying the most effective procedure for patients with malignant diffuse mesothelioma.

S. C. Grondin and D. J. Sugarbaker
Pleuropneumonectomy in the Treatment of Malignant Pleural Mesothelioma*
Chest, December 1, 1999; 116(90003): 450S - 454.
[Abstract](see below)  [Full Text]

Pleuropneumonectomy in the Treatment of Malignant Pleural Mesothelioma^*

Sean C. Grondin, MD and David J. Sugarbaker, MD, FCCP

^* From the Division of Thoracic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

Correspondence to: David J. Sugarbaker, MD, FCCP, Division of Thoracic Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115

Study objectives: Malignant pleural mesothelioma (MPM) is predominantly a local/regional disease that results in a survival time that ranges from 4 to 12 months without treatment. Single-modality therapy using surgery, chemotherapy, or radiotherapy alone is largely ineffective. The objective of the study was presentation of the use of pleuropneumonectomy in a multimodality treatment setting and the results.

Design: Didactic presentation.

Setting: Academic tertiary-care hospital.

Patients: One hundred eighty-three patients who underwent multimodality therapy.

Interventions: Of all the single-modality treatment approaches, pleuropneumonectomy has been associated most consistently with long-term disease-free survival and has provided the greatest amount of tumor cytoreduction. The technique of pleuropneumonectomy traditionally has been linked with high perioperative mortality and morbidity when compared with that of other cytoreductive techniques such as pleurectomy/decortication. Recently, improvements in operative mortality (< 5%) have been reported, largely due to improvements in patient selection and perioperative management. Multimodality therapy, including chemotherapy, radiotherapy, and extrapleural pneumonectomy, was used to treat patients.

Results: Outcomes were presented for 183 patients with MPM who underwent multimodality therapy.

Conclusions: With the development of multimodality therapy, pleuropneumonectomy followed by sequential chemotherapy and radiotherapy has demonstrated a significant survival benefit, especially for patients who have epithelial tumor histology, tumor-free resection margins, and tumor-free extrapleural node status.