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Mesothelioma
Treatment
Articles
and Abstracts
Trimodality
management of malignant pleural
mesothelioma.
Eur
J Cardiothorac Surg 2001
Mar;19(3):346-50
Maggi
G, Casadio C, Cianci R, Rena O, Ruffini E.
Department
of Thoracic Surgery, University of Torino,
San Giovanni Battista Hospital, via Genova
3, 10126, Torino, Italy.
giuliano.maggi@unito.it
OBJECTIVE:
We reviewed our experience with
trimodality management of malignant
pleural mesothelioma (MPM). METHODS: From
September 1998 to August 2000, 32
consecutive patients with histological
diagnosis of MPM underwent trimodality
therapy, including surgery followed by
adjuvant chemotherapy and radiation
therapy. Surgery consisted of
pleurectomy/decortication (P/D) or
pleural-pericardial-pneumonectomy and
diaphragm (PPPD). Pre-operative staging
according to the Brigham Staging System
was accomplished using computed tomography
(CT) and magnetic resonance imaging (MRI);
patients with evident extrapleural spread
were excluded. RESULTS: Our series
included 21 men and 11 women with a median
age of 53.5 years (range 40-69).
Histologically, there were 26 epithelial,
four mixed and two sarcomatous MPM.
Post-surgical staging was as follows: six
patients were at Stage I; of these, two
received a P/D and four a PPPD. Ten
patients were at Stage II and all received
a PPPD; 16 patients were at Stage III
(under-staged pre-operatively): of these,
nine patients presented extrapleural lymph
node metastases (N2) and all received a
PPPD, seven patients presented with chest
wall or mediastinal invasion (T4) with
macroscopic residual tumour, and all
received a de-bulking P/D. We observed
major complications in ten patients: six
bleeding, two respiratory insufficiency
and two nerve paralysis. There were two
perioperative deaths (6.25% mortality).
Twenty-seven patients out of 30 surviving
surgery had a follow-up greater than 6
months; 21 patients out of 27 are alive
with a median follow-up of 12.5 months.
CONCLUSIONS: (1) Trimodality therapy is
feasible in selected patients with MPM and
has an acceptable operative mortality
rate. (2) Our current pre-operative
staging based on CT/MRI looks rather
inaccurate and needs to be improved. (3)
The high rate of post-surgical N2 patients
or with diffusion to the inferior surface
of the diaphragm may suggest the use of
routine mediastinoscopy and laparoscopy
for a more appropriate patient
selection.
PMID:
11251277 [PubMed - indexed for
MEDLINE]
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