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Mesothelioma
Treatment
Articles
and Abstracts
Pleuropneumonectomy
in the Treatment of Malignant Pleural
Mesothelioma(*)
Chest
1999 Dec;116(3 Suppl):450S-454S
Grondin
SC, Sugarbaker DJ
Division
of Thoracic Surgery, Brigham and Women's
Hospital, Harvard Medical School, Boston,
MA.
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 (less
than 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.
PMID:
10593835
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