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1.
Background A minority of patients with malignant pleural mesothelioma (MPM) are considered for surgery. To achieve a microscopically
radical resection, combination with other treatment modalities is mandatory. The most effective combination is unknown. In
our institute we have retrospectively analyzed the results of two combined modality regimens containing surgery.
Patients Between January 2002 and September 2005, 15 MPM patients were treated with extrapleural pneumonectomy (EPP) and postoperative
hemithoracic radiation (RT; 54 Gy). Previously, between January 1999 and December 2001, 20 patients underwent a combination
of cytoreductive surgery – pleurectomy or EPP – and intraoperative hyperthermic intrathoracic chemotherapy (HITHOC), followed
by radiotherapy to the thoracotomy scar and drainage tracts (24 Gy).
Results The median operating time for EPP/RT was shorter (5.3 versus 6.9 h; P < 0.0001). Postoperative complications occurred in 8 EPP/RT patients (53%) and in 14 HITHOC patients (70%). Two HITHOC patients
died postoperatively. Median overall survival was 29 months for EPP/RT patients and 11 months for HITHOC patients (P = ns). The median time to local recurrence was not reached for EPP/RT patients, and was 9 months for HITHOC patients (P = 0.003). Local control was achieved in ten EPP/RT patients (67%) with a follow-up of 5–59 months compared to four HITHOC
patients (20%) with a follow-up of 4–27 months.
Conclusions In highly selected patients local control can be achieved with combination therapy but is accompanied by a high rate of (surgical)
complications. Distant failure rates warrant further studies exploring the role of systemic chemotherapy while the use of
cytoreductive surgery with intraoperative chemoperfusion for MPM is not supported. 相似文献
2.
The management of malignant pleural mesothelioma; single centre experience in 10 years. 总被引:4,自引:0,他引:4
Tarek Aziz Ali Jilaihawi Dhruva Prakash 《European journal of cardio-thoracic surgery》2002,22(2):298-305
BACKGROUND AND OBJECTIVES: Malignant pleural mesothelioma (MPM) is an asbestos-related disease of the pleura with a survival time without treatment ranging from 4 to 12 months. The objective of this study is to review our experience in selection of MPM patients for various modalities of treatment. METHODS: Between 1989 and 1998, 302 patients with MPM have been referred to our Centre for assessment. Majority (191 patients, 61%) of them received no specific treatment. Forty-seven patients were treated by decortication/pleurectomy and 64 had a radical extra-pleural pneumonectomy (EPP). Intrapleural chemotherapy and systemic post-operative chemotherapy was employed only in the last 51 patients following radical surgery. RESULTS: The average survival was 8.9 months for those treated by palliative care only. The average survival was 13 and 14 months for patients treated by radical surgery only or by decortication/pleurectomy, respectively. However, survival has improved to a mean of 35 months for patients treated by radical surgery followed by systemic post-operative chemotherapy. In this group, the survival prevalence was 90 and 70% for T1 patients and 85 and 36% for T2 patients at 1 and 3 years, respectively (P=0.002). Survival was surprisingly, not affected by lymph node involvement (P=0.08) or pathological type of MPM (P=0.07). The operative mortality was 9% for EPP and 0% for decortication/pleurectomy. CONCLUSION: In selected patients with MPM, complete surgical resection by EPP represents an important initial step in their management. Systemic chemotherapy improves survival in surgically treated patients. Further trials are needed to improve on the adjuvant treatment regimes. 相似文献
3.
Apostolos Nakas Antonio E Martin Ucar John G Edwards David A Waller 《European journal of cardio-thoracic surgery》2008,33(1):83-88
OBJECTIVE: Extrapleural pneumonectomy (EPP) has high mortality and morbidity; radical pleurectomy decortication (P/D) carries less mortality but still significant morbidity. This surgery is not suitable for many patients with malignant pleural mesothelioma (MPM) for whom video assisted thoracic surgery (VATS) offers a minimally invasive alternative. We aimed to assess the role of VATS decortication for MPM. METHODS: Over a 9-year period 208 patients underwent therapeutic surgery for MPM in our unit. One hundred and twelve of the patients underwent EPP, 29 had a P/D and 67 had VATS decortication. Sixty-three of the 208 patients (EPP n=13, P/D n=8 and VATS decortication n=42) were 65 years of age or older at the time of the operation (57 males and 6 females, age 70 (65-80) years). In this group we analyzed perioperative morbidity and mortality and long-term survival data using the Kaplan-Meier method. RESULTS: Postoperative stay and 30-day mortality was significantly lower for VATS P/D than for EPP (14.3 days vs 36.6 days, p<0.05 and mortality 7.1% vs 23%, respectively). There was no significant difference in the overall mean survival between the two groups (11.5 months for EPP and 14 months for VATS P/D, p=0.6). CONCLUSION: VATS decortication should be considered in the therapeutic strategy for MPM. 相似文献
4.
Helen W. Pass MD Barbara K. Temeck MD Karen Kranda RN Seth M. Steinberg PhD Dr. Harvey I. Pass MD 《Annals of surgical oncology》1995,2(3):214-220
Background: The treatment of malignant pleural mesothelioma (MPM) continues to be inadequate with the use of standard techniques, including
surgery, radiotherapy and chemotherapy. We initiated a phase II trial of immunochemotherapy with cisplatinum (25 mg/m2 four times weekly), interferon-α (5 mU/m2 s.c. three times weekly), and tamoxifen (20 mg orally twice a day for 35 days) (CIT) based on in vitro and in vivo data suggesting
interrelating efficacy of this combination.
Methods: Since July 1991, 36 patients have been evaluable for response after receiving one to five cycles of CIT. Ten additional patients
had debulking surgery followed by two cycles of postoperative adjuvant CIT commencing a mean of 6 weeks after surgery.
Results: Toxicity was acceptable (4% grade III/IV). One treatment-related death (2%) occurred, from myocardial infarction. A 19% partial
response rate, objectively quantified using three-dimensional computerized tomographic (CT) measurement of solid disease volume,
was recorded. The median survival for the seven responders was 14.7 months, whereas that of the nonresponders was 8 months
(p2=0.2). Median survival for the entire group was 8.7 months. Preoperative size, platelet count >360,000/ml, and nonepithelial
histology were associated with shortened survival.
Conclusions: The CIT regimen has some activity in MPM and can be delivered after debulking resection. In good-risk patients, as defined
by favorable prognostic factors, a randomized trial using this combination may be warranted.
Presented at the 47th Annual Cancer Symposium of The Society of Surgical Oncology, Houston, Texas, March 17–20, 1994. 相似文献
5.
Okada M Mimura T Ohbayashi C Sakuma T Soejima T Tsubota N 《Interactive Cardiovascular and Thoracic Surgery》2008,7(1):102-106
The role of surgical treatment for malignant pleural mesothelioma (MPM) continues to be controversial. We carried out a retrospective review of the prognosis in patients who had radical surgery for MPM. Of 87 consecutive patients on whom surgical exploration for biopsy-proven MPM was performed, 31 patients underwent extrapleural pneumonectomy (EPP) and 34 patients underwent pleurectomy/decortication (P/D). Sixty-five patients having EPP or P/D included 58 men (89%). The median age was 60 years (range 35-78) and the histologic type was epithelial in 48 patients (74%). IMIG staging classification was p-stage I disease in eight patients (12%), p-stage II in 13 (20%), p-stage III in 40 (62%) and p-stage IV in 4 (6%). Operative mortality was 3.2% for EPP and none for P/D. The median and 3-year survivals after EPP were 13 months and 33% whereas those after P/D were 17 months and 24%, respectively. A multivariate analysis demonstrated that older age (P=0.0467), non-epithelial histology (P=0.0057) and p-stage III-IV disease (P=0.0019), but not gender, side, surgical procedure, were significant independent negative prognostic factors. Although P/D appears to be acceptable in early stages, we encourage EPP, en bloc resection without entering the pleural cavity with intent for curability, which provides oncologically complete resection of all disease. 相似文献
6.
Important prognostic factors in patients with malignant pleural mesothelioma, managed surgically 总被引:8,自引:0,他引:8
BACKGROUND: The factors influencing outcome after resection of malignant pleural mesothelioma (MPM) are controversial. This analysis of a prospective surgical database identifies important prognostic factors. METHODS: Tumors were staged by the International Mesothelioma Interest Group staging system, and patients were followed until death. Prognostic factors were analyzed by log rank and Cox regression, and were considered significant if p was less than 0.05. RESULTS: From Oct 1983 to May 1998, 231 patients underwent thoracotomy, 115 had extrapleural pneumonectomy (EPP), and 59 pleurectomy/decortication (P/D). Among patients having EPP or P/D, 142 received adjuvant therapy. The median survival for stage I tumors was 29.9 months, for stage II 19 months, for stage III 10.4 months, and for stage IV 8 months. By multivariate analysis, stage, histology, gender, adjuvant therapy, but not the type of surgical resection, were significant. CONCLUSIONS: The better survival previously reported for P/D compared with EPP is not seen in a large database with long follow-up. Stages I and II have better survival rates than generally assumed for MPM. Locally advanced T and N status, and nonepithelial histology, identify poor prognosis patients who should be considered for novel treatment regimens. 相似文献
7.
Background
Extrapleural pneumonectomy (EPP) has been shown to improve long-term survival outcomes in selected patients with malignant pleural mesothelioma (MPM). The present study aimed to evaluate potential prognostic factors on overall survival for patients who underwent EPP for MPM and to examine the patient selection process in major referral centers that perform EPP. 相似文献8.
Bueno R Reblando J Glickman J Jaklitsch MT Lukanich JM Sugarbaker DJ 《The Annals of thoracic surgery》2004,78(5):1774-1776
Background
Survival after tri-modality therapy with extrapleural pneumonectomy (EPP) and postoperative chemoradiotherapy is longer for patients with epithelial MPM versus mixed or sarcomatoid subtypes, leading some to decline aggressive therapy for patients with nonepithelial histology. However, pathologic diagnosis of malignant pleural mesothelioma (MPM) and subclassification into one of the three histologic subtypes (epithelial, mixed, sarcomatoid) can be challenging. Pleural biopsy has been proposed as the diagnostic gold standard. We investigated the accuracy of open pleural biopsy for diagnosis and subtype identification in MPM.Methods
Patients with suspected MPM routinely undergo open pleural biopsy to establish diagnosis. Those diagnosed definitively by pleural biopsy or cytology are offered pleurectomy or EPP dependent on stage and cardiorespiratory status. We reviewed medical records for all patients undergoing EPP at our institution, comparing tissue and subtype diagnosis at initial diagnostic biopsy versus definitive resection.Results
Between 1988 and 2000, 305 of 332 consecutive patients undergoing EPP had MPM. One patient diagnosed with MPM at pleural biopsy was misclassified. Subtype analysis at pleural biopsy proved correct in 80% (226/282). Most patients (174/192) with epithelial subtype at final diagnosis were diagnosed correctly at pleural biopsy. However, 44% (45/103) with pathologic diagnosis of nonepithelial subtype at resection were initially misdiagnosed with the epithelial subtype. The sensitivity of pleural biopsy for epithelial MPM was 97% with a specificity of 56%.Conclusions
Open pleural biopsy is accurate and should be considered the gold standard diagnostic method for MPM. It is less sensitive for determining histologic subclass, particularly with nonepithelial subtypes. 相似文献9.
MPM is an occupational disease with increasing incidence. From 1986 to 1998 we operated 59 patients for MPM: in 11 cases only biopsy or exploration, 23 (stage T1a and T1b) Pleurectomy/Decortication, 22 (stage T2/3) extended pleuropneumonectomy (PPE) with resection of pericardium and diaphragm. In 3 cases we did additionally a chestwall resection. One patient in the PPE-group died postoperatively. Median survival time in the diagnosis/exploration group is 6 months. In the pleurectomy group (earlier stages) 14 months, in the PPE-group 16 months. One patient in the PPE-group survived 68 months, in the pleurectomy group the longest survival was 39 months. Up today 20 patients in the PPE-group died, 12 without any evidence local recurrency. Despite the fact that patients in the pleurectomy group are operated in earlier tumor stages they do not have a longer median survival time. In more than 50 percent only local disease control can be achieved by ePPE. Therefore in my opinion the first operative step must be followed by a second therapeutic step as immune- or gene therapy. 相似文献
10.
Cao C Krog Andvik SK Yan TD Kennedy C Bannon PG McCaughan BC 《Interactive Cardiovascular and Thoracic Surgery》2011,12(5):754-757
Extrapleural pneumonectomy (EPP) has been established as a viable surgical option in the treatment of malignant pleural mesothelioma (MPM) for selected patients. A number of pathological staging systems have been developed to prognosticate survival outcomes. We assessed 91 patients with MPM who underwent EPP in our institution and evaluated the applicability of the most updated staging systems in the current literature. After a mean follow-up of 20 months, the median overall survival was 27.6 months. Postoperative pathological staging according to the International Mesothelioma Interest Group criteria (P = 0.026) and the Brigham and Women's Hospital criteria (P = 0.039) were both found to be significant prognostic factors. Adjuvant chemotherapy (P = 0.022) and radiotherapy (P = 0.008) were associated with improved survival outcomes. These findings are consistent with previous reports that demonstrated the usefulness of pathological staging systems as a prognostic tool in patients with MPM after undergoing EPP. However, preoperative clinical staging systems need to be developed to facilitate the patient selection process prior to surgery. 相似文献
11.
Dr. Harvey I. Pass MD Barbara K. Temeck MD Karen Kranda RN Gunther Thomas PhD Angelo Russo MD PhD Paul Smith BS Walt Friauf BS Seth M. Steinberg PhD 《Annals of surgical oncology》1997,4(8):628-633
Background: Patients with malignant pleural mesothelioma (MPM) usually die of progressive local disease. This report describes the results
of a Phase III trial comparing maximum debulking surgery and postoperative cisplatin, interferon α-2b, and tamoxifen (CIT)
immunochemotherapy with and without intraoperative photodynamic therapy (PDT) to determine (1) whether such a multimodal approach
can be performed with minimum morbidity and mortality in malignant pleural mesothelioma (MPM), and (2) whether first-generation
(i.e., 630-nm laser light, Photofrin II) intrapleural PDT impacts on local recurrence or survival.
Methods: From July 1993 to June 1996, 63 patients with localized MPM were randomized to either PDT or no PDT. The tumors of 15 patients
could not be debulked to 5 mm. Patients assigned to PDT (n=25) and no PDT (n=23) were similar with respect to age, sex, tumor
volume, and histology.
Results: The type of resection (11 pleurectomies and 14 pneumonectomies vs. 12 pleurectomies and 11 pneumonectomies), length postoperative
stay, and ICU time were comparable (PDT vs. no PDT). There was one operative death (hemorrhage), and each group had two bronchopleural
fistulas. Postoperative staging divided patients into the following categories: stage I: PDT, 2, no PDT, 2; stage II: PDT,
2, no PDT, 2; stage III, PDT, 21; no PDT, 17; stage IV, PDT, 0; 0; no PDT, 2. Comparable numbers of CIT cycles were delivered.
Median survival for the 15 non-debulked patients was 7.2 months, compared to 14 months for the 48 patients on protocol. There
were no differences in median survival (14.4 vs. 14.1 months) or median progression-free time (8.5 vs. 7.7 months), and sites
of first recurrence were similar.
Conclusions: Aggressive multimodal therapy can be delivered for patients with higher stage MPM. First-generation PDT does not prolong
survival or increase local control for MPM.
Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997. 相似文献
12.
PurposePartial nephrectomy is increasingly used in children with bilateral Wilms' tumor (BWT) or contralateral recurrence. Nephron-sparing surgery seeks to achieve complete tumor removal while preserving functional renal parenchyma. Previous series have documented high rates of complications, recurrence, and mortality.MethodsTwelve patients (4 boys and 8 girls aged 9-42 months) with BWT or contralateral recurrence were treated at our institution with unilateral or bilateral partial nephrectomy. Preoperative imaging, operative notes, and pathology reports were reviewed. Outcomes analyzed included complications, recurrence, readmission rate, postoperative glomerular filtration rate (GFR), and survival.ResultsAll patients underwent successful nephron-sparing resection using standard techniques, with only 2 patients requiring unilateral nephrectomy. Median length of stay was 3 days. There were no major complications or urine leaks. Two patients were lost to follow-up. The remaining 10 were followed up for a median of 36 months (range, 3-79 months). There have been no recurrences or unplanned readmissions. Mean GFR is 107.7 (±32.8) mL/min per 1.73 m2, with no patient having a GFR below the lower limit of normal for age.ConclusionNephron-sparing resection is a safe and effective approach for children with BWT or contralateral recurrence and should be part of the multimodality therapeutic approach to this disease. 相似文献
13.
Hosokawa Y Matsuge S Hayashi K Kawahara Y Ishigooka M Kan T Yamaawa T Hatakeyama H Murakami Y 《Kyobu geka. The Japanese journal of thoracic surgery》2004,57(11):1018-1022
Standard treatment for malignant pleural mesothelioma (MPM) has not been proved yet. However, it has been recognized that extrapleural pneumonectomy (EPP) is a treatment of choice for epithelial MPM when combined with adjuvant therapies though EPP may frequently cause fetal complications. We report 5 cases of MPM with EPP, including 1 with good prognosis. Sixteen patients with MPM were admitted to our hospital between 1988 and 2003. Five patients underwent EPP, among which 4 were male and 1 female with ages from 46 to 61 years old. Histologically, 3 of them were epithelial and 2 were biphasic. Those with biphasic experienced acute respiratory failure and empyema, and died 81 days and 8 months after the surgery respectively. Among those with epithelial MPM, 2 are alive with no recurrence at 129 and 29 months after the surgery, and the other, followed by postoperative radiotherapy, died at 12 months. More cases with EPP or randomized controlled trials regarding EPP are necessary to evaluate efficacy of EPP for MPM. 相似文献
14.
Malignant pleural mesothelioma: clinicopathologic and survival characteristics in a consecutive series of 394 patients. 总被引:1,自引:0,他引:1
Piero Borasio Alfredo Berruti Andrea Billé Paolo Lausi Matteo Giaj Levra Roberto Giardino Francesco Ardissone 《European journal of cardio-thoracic surgery》2008,33(2):307-313
OBJECTIVE: Treatment of malignant pleural mesothelioma (MPM) remains disappointing, although recent reports suggest that multimodality therapy including surgery may provide a significant survival benefit. The aims of this single institution study were: to investigate clinicopathologic characteristics and potential prognostic factors in MPM patients, and to ascertain whether surgery followed by adjuvant therapy had an independent prognostic role. METHODS: Retrospective review of a prospectively compiled computerized database of all patients with MPM evaluated between 1989 and 2003. Kaplan-Meier method, log-rank test, and Cox model were used in the statistical analysis. RESULTS: There were 394 patients: 270 men (68.5%), 124 women, median age 64 (range 28-93). Twenty-seven patients (6.8%) underwent surgical resection (extrapleural pneumonectomy 15, pleurectomy/decortication 12), followed by adjuvant therapy. As of March 2006, 381 patients (96.7%) had died (median survival, 11.7 months; range 0.03-117.9). Median follow-up of 13 surviving patients (3.3%) was 45.2 months (range 28.7-126.5). Overall survival at 2 years was 18.8%. Multimodality therapy including surgery yielded a median survival of 14.5 months and a 2-year survival rate of 29.6%. Using univariate analysis, age (p=0.009), chest pain (p=0.01), weight loss (p=0.001), performance status (p=0.0001), platelet count (p=0.008), histology (p=0.0001), macroscopic appearance of pleural surface (non-specific inflammation, tumor-like thickening, or nodules; p=0.0001), visceral pleura involvement (p=0.0001), degree of involvement of pleural cavity (less than or more than one third of the cavity; p=0.0001), and multimodality therapy (p<0.01) were found to be significant prognostic factors. At multivariate analysis, performance status, platelet count, histology, and degree of involvement of pleural cavity remained independently associated with survival, whereas multimodality therapy failed to enter the model. CONCLUSIONS: Significant predictors of survival include performance status, platelet count, histology, and degree of involvement of pleural cavity. Within the confines of this retrospective study and the small number of patients undergoing multimodality therapy, the role of surgery in the treatment of MPM remains unclear. Further investigation is warranted to determine the optimal treatment strategy in this disease. 相似文献
15.
《Asian journal of surgery / Asian Surgical Association》2023,46(1):360-365
BackgroundIt is aimed to determine the prognostic values of preoperative inflammatory biomarkers in patients undergoing curative surgery for gastric carcinoma and to contribute to the development of prognostic modeling.ObjectiveTo investigate the effect of various different preoperative inflammatory markers on the prognosis of gastric carcinoma.Material and methodThe medical data and the mortality status of 91 patients who underwent total or subtotal gastrectomy operation for gastric carcinoma at Mersin City Training and Research Hospital between 2016 and 2020 were retrospectively reviewed from the hospital records and patient files. The patients' demographic characteristics, tumor location, histopathological diagnosis, pathological stage, tumor markers, and preoperative inflammatory and hematological markers were analyzed. Based on these data, tumor stage, metastatic lymph node ratio (MLR), lactate dehydrogenase albumin ratio (LAR), neutrophil-lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) were calculated. The relationship between these parameters and postoperative survival was analyzed. Statistical analyses were performed with IBM SPSS for Windows, version 17.0 (IBM Corporation, Armonk, New York, United States).ResultsThe correlation analysis of the parameters affecting survival showed that, in addition to an advanced tumor stage, inflammatory parameters like NLR, PLR, and LAR adversely affected survival.ConclusionPreoperative NLR, PLR, LAR, and advanced tumor stage may help determine the survival of gastric carcinoma patients. Multiple studies with larger series are needed on this subject. 相似文献
16.
C. Iacono E. Facci L. Bortolasi G. Zamboni A. Scarpa G. Talamini G. Prati F. Nifosí G. Serio 《Journal of Hepato-Biliary-Pancreatic Surgery》1999,6(1):74-78
Background. Extended pancreaticoduodenectomy (EPD) with retroperitoneal lymphatic, neural, and connective clearance has been proposed
to improve survival in patients with carcinomas of the head of the pancreas. The open questions are: does EPD allow better
staging of the tumor? Does it reduce local recurrences? And does it improve survival?
Method. We treated 26 patients by EPD between January 1994 and September 1996. Eighteen patients had pancreatic ductal carcinoma,
7, periampullary carcinoma; and 1, intraductal papillary mucinous carcinoma.
Results. The pancreatic cancers were International Union against Cancer (UICC) stage I in 3 patients, stage III in 14, and stage IV
in 1. Two patients with stage III disease would have been considered as having stage I without EPD. Pancreatic cancer and
periampullary carcinoma patients had a 3-year actuarial survival of 32% and 86%, respectively. At a mean follow-up time of
22.5 months (range, 6–39 months), 3 pancreatic cancer patients (16.6%) had loco-regional recurrences, 6 patients (33%) had
distant metastases, and 1 (5.5%) had distant and loco-regional recurrences. Only 1 of 7 patients with periampullary carcinoma
had distant metastasis 20 months after resection.
Conclusion. EPD seems to decrease the rate of local recurrences and allows more correct staging. The intermediate survival results are
encouraging but a definitive conclusion awaits longer follow-up.
Received for publication on July 1, 1998; accepted on Aug. 28, 1998 相似文献
17.
18.
OBJECTIVE: Two different surgical methods for treating mesothelioma (pleurectomy and pleuro pneumonectomy) were reviewed. METHODS: This was a retrospective study from 1976 to 2001. Forty-six patients, aged 35-80 years, received one of the following procedures: pleurectomy (n=29), or pleuro pneumonectomy (n=17). Pleurectomy was indicated in symptomatic patients with pain or pleural effusion while pleuro pneumonectomy was indicated in patients with Butchart stage I or II disease and an acceptable cardiopulmonary reserve. Patients received either chemotherapy, radiation, or in combination after surgery. RESULTS: The mortality rate was 3.8% for pleurectomy patients and 5.8% for pleuro pneumonectomy patients. The median survival rate for pleurectomy patients was 9 months, and 12 months for pleuro pneumonectomy patients. Pleuro pneumonectomy patients experienced less morbidity and had a shorter hospital stay than pleurectomy patients. CONCLUSIONS: Improved survival was obtained with both procedures. Morbidity was higher in the patients who underwent pleurectomy. Important prognostic factors include tumor stage, tumor histology, duration of symptoms, and weight loss or pain as a presenting symptom. Patients with a low tumor stage, epithelial histology, absence of pain or weight loss, and a longer onset of symptoms had the best survival rate. A trend towards improved survival in patients undergoing pleuro pneumonectomy and receiving radiation as adjuvant therapy was observed. 相似文献
19.
AIM: Even though followed by a prolonged survival in highly selected patients, the promising results of Sugarbaker's trimodality treatment for malignant pleural mesothelioma (MPM) are debated and not yet uniformly replicated.The purpose of this study is to evaluate prospectively the reproducibility of the trimodality treatment results in a patient population with mesothelioma staged by the IMIG classification. METHODS: Fifty-four patients with MPM have been judged candidable to extended pleuropneumonectomy (EPP), to be followed by chemotherapy (paclitaxel+carboplatin) and radiotherapy (50 Gy). RESULTS: At thoracotomy, 44 of the 54 surgical candidates (81%) underwent EPP; 73% of the operated patients completed the entire adjuvant chemo-radiotherapy with no major toxicity. The 30-day or in-hospital operative mortality rate was 4.5% (2 deaths), the major morbidity 36%, and the overall complication rate 50%. At 5 years the projected survival of the 42 surgical survivors submitted to EPP is 19%; median survival is 20 months. The restricted group of patients with epithelial, N0-1, completely resected MPM (microscopic negative margins) exhibits a projected 50% 5-year survival. Clinical understaging has shown up to be noticeable both at the thoracotomy exploration and pathology examination. Most of the disease recurrences are loco-regional and the current insufficiency of intraoperative or postsurgical radicality needs improvement, along with earlier diagnosis, more accurate staging, and preoperative induction for the multimodality treatment of pleural mesothelioma to become an established curative option. CONCLUSIONS: This series confirms the reproducibility of the trimodality treatment for MPM,which is associated with prolonged survival for early-stage tumors at the cost of a not prohibitive treatment-related mortality rate. 相似文献
20.
Andrew L. Feldman MD H. Richard Alexander Jr. MD David L. Bartlett MD Douglas L. Fraker MD Steven K. Libutti MD 《Annals of surgical oncology》1999,6(6):562-567
Background: Despite high rates of complete responses (CRs) to isolated limb perfusion (ILP) for patients with in-transit melanoma (60% to 90%), extremity recurrences are common. We evaluated our experience with managing these recurrences to determine how best to treat these patients.Methods: Between April 1992 and April 1998, 72 patients experienced CRs after hyperthermic ILP using Melphalan, with (n = 46) or without (n = 26) tumor necrosis factor. Of these, 25 patients (35%) experienced initial recurrences in the extremities, and they form the basis of this study.Results: Three patients who underwent repeat ILP for treatment of their recurrences experienced a second CR and recurrence in the extremity (at 9, 15, and 16 months), allowing analysis of 28 cases. For 5 of 20 recurrences managed with excision, 2 of 6 managed with repeat ILP, and 0 of 2 managed with systemic treatment, the patient was free of disease at the last follow-up examination (median follow-up period, 11 months).Conclusions: Isolated extremity recurrences after CRs to ILP occurred in 35% of patients. Initially, these could be managed successfully by excision or repeat ILP for the majority of patients (92%). We recommend excision of small-volume recurrent disease, reserving repeat ILP for patients with increasing numbers of lesions or increasing rapidity of in-field recurrences. 相似文献