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S. Hasegawa
Moderator of
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OA 02 - Mesothelioma: Challenges For New Treatment (ID 653)
- Event: WCLC 2017
- Type: Oral
- Track: Mesothelioma
- Presentations: 8
- Moderators:S. Hasegawa, Anna Nowak
- Coordinates: 10/16/2017, 11:00 - 12:30, F205 + F206 (Annex Hall)
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OA 02.01 - Randomized Phase II Study of Anetumab Ravtansine or Vinorelbine in Patients with Malignant Pleural Mesothelioma (ID 9377)
11:00 - 12:30 | Presenting Author(s): Hedy Lee Kindler | Author(s): Silvia Novello, Dean A Fennell, G. Blumenschein, A. Bearz, G.L. Ceresoli, J.G. Aerts, J. Spicer, P. Taylor, A. Greystoke, K. Nackaerts, Luana Calabro, S. Burgers, R. Jennens, A.F. Sporchia, A. Walter, J. Siegel, B.H. Childs, C. Elbi, R. Hassan
- Abstract
- Presentation
Background:
Anetumab ravtansine (BAY 94-9343) is a novel fully human anti-mesothelin IgG1 antibody conjugated to the maytansinoid tubulin inhibitor DM4. We report the results of a randomized phase II trial of anetumab ravtansine compared to vinorelbine in patients with advanced malignant pleural mesothelioma (MPM) who have high mesothelin expression and have progressed on platinum/pemetrexed-based first-line chemotherapy (NCT02610140).
Method:
Patients (≥18 years) with locally advanced or metastatic MPM with progressive disease following first-line treatment with pemetrexed-based chemotherapy, with or without bevacizumab, were eligible. Patients were pre-screened based on obligatory tumor staining for mesothelin as determined by the Ventana MSLN (SP74) immunohistochemistry assay. The primary efficacy endpoint was progression-free survival (PFS) per central radiologic review using modified RECIST criteria for MPM. Secondary objectives included overall survival, tumor response, and safety. Patients were randomized in a 2:1 ratio to anetumab ravtansine 6.5 mg/kg Q3W IV or vinorelbine 30 mg/m[2] QW IV.
Result:
A total of 166 patients were randomized to anetumab ravtansine and 82 to vinorelbine; 3 and 10 patients, respectively, not receiving treatment were included for efficacy but not safety assessments. The treatment arms were evenly balanced, with 73% male, 64% ECOG performance status 1, 96% epithelioid histology, and a mean 2.5 (±2.4) months since last progression. The median duration of treatment (anetumab vs vinorelbine) was 12.6 weeks (range 3-61) vs 13.0 weeks (range 1-43). Treatment-emergent grade (G) ≥3 adverse events (AEs) were seen in 85 (52.1%) and 53 (73.6%) of patients, respectively. G3/G4 neutropenia (22.2%/16.7%) occurred in the vinorelbine arm whereas corneal epitheliopathy (39.3% all grade, 1.8% G3) was distinct for the anetumab ravtansine arm. Serious AEs (any grade) were similar; 52 (31.9%) vs 25 (34.7%). Treatment-emergent AEs leading to dose modification were 42.9% in the anetumab ravtansine arm and 80.6% in the vinorelbine arm. There was one treatment-related G5 event in each arm. Median PFS was 4.3 months (95% CI:4.1, 5.2) for anetumab ravtansine vs 4.5 months (4.1, 5.8) for vinorelbine; hazard ratio 1.22 (0.85, 1.74), p=0.859. Fourteen (8.4%) patients in the anetumab ravtansine arm had an objective response vs 5 (6.1%) in the vinorelbine arm, with no complete responses. Interim median overall survival was 10.1 mo (7.6, -) vs 11.6 mo (7.7, 12.5), respectively, p-value 0.721.
Conclusion:
In relapsed MPM, anetumab ravtansine was not superior to vinorelbine with respect to PFS.
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OA 02.02 - Ipilimumab and Nivolumab in the Treatment of Recurrent Malignant Pleural Mesothelioma: A Phase II Study (ID 9389)
11:00 - 12:30 | Presenting Author(s): Paul Baas | Author(s): M. Disselhorst, E. Harms, H. Van Tinteren, J. Quispel-Janssen, K. Monkhorst, S. Burgers
- Abstract
- Presentation
Background:
There is an increasing interest in the use of IO therapy in Mesothelioma (MPM). We previously reported on the effect of nivolumab (s.a) in patients with recurrent MPM with a disease control rate of 50% at 12 weeks. We therefore decided to test the effect of the combination of nivolumab and ipilimumab in recurrent MPM.
Method:
Patients with previously treated MPM and a PS of 0-1 are consented in this single arm prospective study. Pleural lesions must be available for biopsy before and after 6 weeks of treatment.Nivolumab is administered at a fixed dose of 240 mg (q2w) until progression and combined with ipilimumab (1mg/kg) on week 1, 7, 13 and 19. CT scans are performed every 6 weeks for analysis and duration of response. The primary endpoint is disease controle rate at 12 weeks. Translational research is performed on paired biopsies. A Simon’s minimax two-stage design is used to identify a DCR of >50%. Therefore 33 patients will be included.
Result:
From October 2016 until August 2017 38 patients gave informed consent. Three patients did not start due to progression or impossibility to biopsy. Two stopped after 1 cycle (due to progression or withdrawn consent). At time of analysis (August 29) 25 patients could be evaluated for response. At 12 weeks a DCR of 72% (18/25) and ORR of 28% (7/25) is observed. Two patients continued treatment after progression at 6 weeks; 1 achieved a PR after 4 months , and the other one is stable. Of the first 11 patients that have been in study for 6 months, 5 have PR, 1 SD and 4 PD. Toxicity is mild. SAE’s reported in the 38 patients occurred in 11 patients with grade 3 or 4 toxicity. No grade 5 toxicity was observed.
Conclusion:
In this interim analysis nivolumab plus ipilimumab meets the primary endpoint for patients with recurrent malignant mesothelioma. Toxicity is mild. The full data set will be presented at the WCLC.
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OA 02.03 - Prophylactic Irradiation of Tracts (PIT) in Patients with Pleural Mesothelioma: Results of a Multicentre Phase III Trial (ID 7980)
11:00 - 12:30 | Presenting Author(s): Corinne Faivre-Finn | Author(s): Neil Bayman, W. Appel, L. Ashcroft, David Raymond Baldwin, A. Bates, Liz Darlison, J.G. Edwards, V. Ezhil, D. Gilligan, M. Hatton, T. Mansy, M.D. Peake, L. Pemberton, Robert Campbell Rintoul, D.J. Ryder, P. Taylor
- Abstract
- Presentation
Background:
It has been widespread practice across Europe to irradiate diagnostic or therapeutic chest wall (CW) intervention sites in patients with malignant pleural mesothelioma (MPM) post-procedure - a practice known as prophylactic irradiation of tracts (PIT). This study aims to determine the efficacy of PIT in reducing the incidence of CW metastases following a chest wall procedure in MPM.
Method:
In this multicentre phase III randomised controlled trial, MPM patients following a chest wall procedure were randomised 1: 1 to receive PIT (within 42-days of procedure) or no PIT. Large thoracotomies, needle biopsy sites and indwelling pleural catheters were excluded. PIT was delivered at a dose of 21Gy in 3 fractions over 3 consecutive weekdays using a single electron field adapted to maximise coverage of the tract from skin surface to pleura. The primary outcome was the incidence of CW metastases within 6 months from randomisation, assessed in the intention-to-treat population. Stratification factors included epitheloid histology and intention to give chemotherapy. Trial registration number NCT01604005.
Result:
375 patients (186 PIT and 189 no PIT) were randomised between 06/2012-12/2015 from 54 UK centres. Comparing PIT vs no PIT, %male patients was 89.8/88.4%, median age 72.8/74.6 years, %ECOG PS (0,1,2) 32.2,56.5,11.3/23.8,56.1,20.1%, %confirmed epithelioid histology 79.6/74.1%, and %with intention to give chemotherapy 71.5/71.4%. The chest wall procedures were VATS (58.1/51.3%), open surgical biopsy (2.7/5.3%), local-anaesthetic-thoracoscopy (26.9/27.0%), chest drain (5.9/8.5%) and others (6.5/7.9%) for the PIT vs no PIT arm respectively. Radiotherapy was received as intended by 181/186 patients in the PIT arm. The proportion of CW metastases by 6 months was 6/186 (3.2%) vs 10/189 (5.3%) for the PIT vs no PIT arm respectively (odds ratio 0.60 [95% CI 0.17-1.86]; p=0.44) and by 12 months 15/186 (8.1%) versus 19/189 (10.1%) respectively (OR=0.79 [95% CI 0.36-1.69];p=0.59). Cumulative incidence of CW metastases at 6months/12 months/24 months was 3.3/8.5/10.0% in the PIT arm vs 5.6/10.9/18.7% in the no PIT arm. Evaluable patients who developed CW metastases reported a mean increase in visual analogue scale pain score of 13.3 (p<0.01) compared to baseline. Skin toxicity was the most common radiotherapy-related adverse event in the PIT arm with 96(51.6%) grade 1, 19(10.2%) grade 2, and 1(0.5%) grade 3 radiation dermatitis (CTCAE V4.0). There were no other grade 3 or higher radiotherapy-related adverse events.
Conclusion:
There is no role for the routine use of PIT following diagnostic or therapeutic CW procedures in patients with MPM.
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OA 02.04 - Discussant - OA 02.01, OA 02.02, OA 02.03 (ID 10827)
11:00 - 12:30 | Presenting Author(s): Daniel H. Sterman
- Abstract
- Presentation
Abstract not provided
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OA 02.05 - RESPECT-MESO: An International Randomised Controlled Trial to Assess Early Specialist Palliative Care in Malignant Pleural Mesothelioma (ID 8880)
11:00 - 12:30 | Presenting Author(s): Fraser Brims | Author(s): S. Gunatilake, I. Lawrie, L. Marshall, C. Fogg, N. Maskell, K. Forbes, N. Rahman, S. Morris, S. Gerry, A. Chauhan
- Abstract
- Presentation
Background:
Malignant pleural mesothelioma (MPM) has a high symptom burden and early specialist palliative care (SPC) may have a beneficial role for these patients. We examined the effect of early SPC in patients with MPM.
Method:
Participants with newly diagnosed MPM (within the last 6 weeks) were randomised to early SPC integrated with standard care, or standard care alone, in a 1:1 ratio. SPC visits were 4 weekly throughout the study period. Quality of life (QoL) and mood were assessed at baseline and every 4 weeks for up to 24 weeks with the EORTC QLQ–C30 questionnaire for QoL and General Health Questionnaire (GHQ-12) for anxiety/depression. The primary outcome was the change in EORTC C30 Global Health Status (GHS) QoL 12 weeks after randomisation.
Result:
174 participants underwent randomisation with 148 (85.1%) completing the primary outcome. The two groups were well matched after randomisation. Median (IQR) age was 72.6 (68.5-78.3) years and 139 (79.9%) were male. Epithelioid was the most common MPM subtype in 136 (78.2%) cases, ECOG PS was 0 in 66 (37.9%) and 1 in 108 (62.1%) participants. At randomisation, 134 (77.0%) participants reported dyspnoea and 100 (57.4%) had chest pain. At least 1 cycle of chemotherapy was completed in 103 (59.2%) participants. At 24 weeks 30 (17.2%) participants had died. Table 1 presents the primary and secondary outcome data. 68 (78.2%) participants in the intervention arm completed all scheduled monthly SPC visits at 12 weeks, and 46 (52.9%) at 24 weeks. 15 (17.2%) participants in the control arm were referred to SPC within 12 weeks, and 30 (34.5%) by 24 weeks.Table 1. Primary and secondary outcomes
Control SPC Mean difference* p= Mean (SD) GHS QoL 12 weeks 59.5 (SD 21.2) 60.2 (23.6) 1.8 (95% CI -4.0 to 8.5) 0.60 Mean (SD) GHS QoL 24 weeks 63.7 (SD 19.8) 61.3 (20.8) -2.0 (-8.8 to 4.6) 0.55 Mean (SD) GHQ-12 anxiety / depression scores 12 weeks 2.6 (3.2) 2.2 (3.0) -0.6 (-1.5 to 0.4) 0.24 Mean (SD) GHQ-12 anxiety / depression scores 24 weeks 2.1 (2.55) 1.75 (2.5) -0.4 (-1.2 to 0.4) 0.28 Median (95% CI) survival (months) 12.6 (10.7-19.7) 11.5 (9.8-15.9) - 0.51 Mean (SD) GHS QoL alive after 6 months of randomisation 60.9 (20.9) (n=66) 64.3 (19.9) (n=63) - - Mean (SD) GHS QoL in those who died within 6 months of randomisation 46.4 (21.4) (n=7) 38.9 (30.6) (n=12) 3.9 (-2.8 to 10.7)** 0.25 * adjusted for baseline score; ** post hoc analysis SPC = specialist palliative care; SD = standard deviation; CI = confidence interval; GHS = Global Health Status (from EORTC QLQ–C30; higher score – better QoL); GHQ = General Health Questionnaire (higher score - higher depression/anxiety)
Conclusion:
Provision of early palliative care for all patients with recently diagnosed MPM is not associated with beneficial changes in quality of life as compared to palliative care review based on symptom burden.
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OA 02.06 - Radioimmunotherapy Combining CTLA-4 Blockade or Low-Dose Cyclophosphamide with Local Radiation in Murine Malignant Mesothelioma (ID 8843)
11:00 - 12:30 | Presenting Author(s): Mikihiro Kohno | Author(s): L. Wu, L. De La Maza, Z. Yun, M. Chan, Y. Yao, Y. Zhao, Marc De Perrot
- Abstract
- Presentation
Background:
Our group has developed a new approach focusing on Surgery for Mesothelioma After Radiation Therapy (SMART), with encouraging results in a phase I/II clinical trial. The impact on the immune system of high-dose hypofractionated radiation therapy is expected to open the door for new combination therapy of immunotherapy and radiation to optimize their synergism on the immune system. The aim of this study is to investigate the antitumor effect of non-ablative hypofractionated radiation combined with anti-CTLA-4 antibody (a-CTLA-4) or low-dose cyclophosphamide (LD-CTX) in murine malignant mesothelioma model.
Method:
Balb/c mice were subcutaneously injected with murine mesothelioma AB12 cells into the left flank on day 0 (primary tumor) and into the right flank on day 7 (secondary tumor). Local radiotherapy (LRT) 5 Gy was delivered to primary tumor once daily for 3 consecutive days (total dose: 15 Gy). Mice were randomized into six groups: (1) No treatment, (2) LRT, (3) a-CTLA-4, (4) LRT+a-CTLA-4, (5) LD-CTX, (6) LRT+LD-CTX. We assessed local and abscopal effects by measuring primary and secondary tumor growth. Furthermore, CD4+ and CD8+ T cell proportion in tumor, spleen and peripheral blood were determined by flow cytometry.
Result:
Mice treated with LRT+a-CTLA-4 and LRT+LD-CTX showed the most significant deceleration in primary tumor growth compared to the other 4 groups. Both combination groups showed similar antitumor effects on the primary tumor. The secondary tumor growth tested the abscopal effect tended to be decreased in mice treated with LRT and LRT+a-CTLA-4 or LRT+LD-CTX compared to untreated mice, but the difference was not significant. Quantification of tumor-infiltrating T cells by flow cytometry showed that the percentages of total T cells, and CD4+ and CD8+ T cells in the primary tumor were increased in the combination groups.
Conclusion:
Combination of LRT and immunotherapy showed synergistic antitumor effects in controlling irradiated-tumor growth. CTLA-4 blockade and LD-CTX might be good candidates in combination with radiotherapy.
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OA 02.07 - Surgical Selection in Pleurectomy Decortication for Mesothelioma – an Overview from Screening and Selection from MARS 2 Pilot (ID 10185)
11:00 - 12:30 | Presenting Author(s): Eric Lim | Author(s): M. Trialists
- Abstract
- Presentation
Background:
Encouraging survival has been reported with pleurectomy decortication (PD) for malignant pleural mesothelioma (MPM) in several surgical case series. However, doubts remain over the degree of selection bias that constitutes the final composition of these series which therefore lead to questions surrounding the validity of the reported outcomes. We have reviewed our initial experience in the MARS 2 study to analyse this surgical selection process in more detail.
Method:
The MARS 2 pilot is randomised trial of RCT of 14 UK centres recruiting into a cisplatin/pemetrexed with or without the addition of PD for meseothelioma in those who remain suitable after an induction two cycle regime. We completed the pilot to analyse screening, eligibility, consent and randomisation data to estimate the eventual pool of patients considered suitable for surgery.
Result:
From 19 Jun 2015 to 5 Dec 2016, 331 patients were screened from the participating centres. In total, 254 patients were excluded, 176 for failed screening and 78 who declined participation. Of the 176, who failed screening the reasons were non resectable disease (74), poor performance status (24), not fit for surgery (4), not mesothelioma (6), death (5) and other (63). From the 331 screened participants, 77 were enrolled to and received the initial two cycles of chemotherapy and a further 21 withdrew. The reasons for withdrawal were declining randomisation (5), progressive disease (10) and other reasons (6), leaving 56 participants randomised into the trial.
Conclusion:
Screening data of a prospective randomised trial (MARS 2) has provided a unique insight into the detailed selection process for PD for MPM. Exclusions occurred at multiple points in the pathway but these have identified potential points for intervention in patient education, staging and fitness assessment and the proportion of tumour progression which will inform the forthcoming phase III study. The clear extent of possible selection bias underscores the importance of evaluating the efficacy of surgery within the context of this randomised trial to be able derive robust estimates of treatment effect.
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OA 02.08 - Discussant - OA 02.05, OA 02.06, OA 02.07 (ID 10828)
11:00 - 12:30 | Presenting Author(s): Prasad S. Adusumilli
- Abstract
- Presentation
Abstract not provided
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Author of
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P1.14 - Radiotherapy (ID 700)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.14-005 - Development of a Novel Spacer to Reduce Mediastinal Organ Toxicity from Stereotactic Body Radiotherapy (ID 7447)
09:30 - 16:00 | Author(s): S. Hasegawa
- Abstract
Background:
Recently, stereotactic body radiotherapy (SBRT) has become available for patients who are at high risk for lung resection. Although SBRT for peripheral lung tumors produces excellent outcomes with low toxicity, it is associated with an increased risk of severe toxicity when used to treat central tumors. We hypothesized that using a spacer designed to provide a predetermined distance between the target lesion and mediastinal organs may reduce adjacent organ toxicity, thereby expanding the indication of SBRT for lung cancer.
Method:
We developed a novel silicon-based spacer that imitated the shape of a canine’s left mediastinum. Animal experiments were performed on canine models to evaluate the feasibility, utility, and safety of the spacer. Two adult beagle dogs were used in this study. Video-assisted thoracoscopic surgery (VATS) was performed through two ports to insert the spacer between the lung and mediastinum of the left thoracic cavity. CT examination was performed with the spacer inflated at 1 week and 2 weeks after insertion. Four weeks after insertion, the spacer was removed. We created two virtual tumors that presented a high risk of severe mediastinal organ toxicity from SBRT. Radiation treatment planning of SBRT was conducted in both cases, and the radiation dose for mediastinal organs was compared between the cases with and without the spacer.
Result:
The spacer could be safely inserted between the lung and mediastinum via the VATS procedure. The novel spacer provided a distance of 5-10 mm between the virtual tumor and the mediastinal organs. The reduced radiation dose for risk organs were calculated as 7.0-27.5% in the aorta, 3.0-12.3% in the esophagus, and 7-25% in the spine. The spacer did not adhere to the mediastinal organs, and was removed smoothly. Figure 1
Conclusion:
The novel mediastinal spacer may potentially reduce mediastinal organ toxicity from SBRT when treating centrally located lung tumors.
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P2.09 - Mesothelioma (ID 710)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Mesothelioma
- Presentations: 2
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.09-005a - Clinical Characteristics of Early Stage, Malignant Pleural Mesothelioma (ID 10043)
09:30 - 16:00 | Author(s): S. Hasegawa
- Abstract
Background:
While the mortality rate has markedly improved for primary lung cancer, a disease that used to be incredibly difficult to treat, the prognosis for malignant pleural mesothelioma (MPM) is as poor as ever, with a mean survival time (MST) after diagnosis of about 1 year. Therefore, it is thought that the most practical method of obtaining better survival times than those associated with currently available treatment options is diagnosing MPM at an earlier stage than is possible now. We performed a retrospective study to evaluate the clinical characteristics of early stage MPM.
Method:
The study included 83 patients with a definitive MPM diagnosis of International Mesothelioma Interest Group (IMIG) clinical stage T0-1a/1bN0M0. We selected 40 patients who did not exhibit significant fluorodeoxyglucose (FDG) accumulation (<2.5) in FDG-positron-emission tomography (PET) prior to starting treatment, and then retrospectively examined their clinical characteristics.
Result:
There were 4 women in this study, 5 patients with no history of asbestos exposure, 37 patients with epithelial histology, 3 patients with biphasic histology, and 3 patients with negative cytology. All patients had pleural effusion.
Conclusion:
Although this was a retrospective study, we found that among T0-1a/1bN0M0 and PET-negative MPM patients, positive cytology (class IV/V) and histology (biphasic) were factors associated with a poor prognosis.
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P2.09-007 - Pleural Biopsy in Patients Suspected of Malignant Pleural Mesothelioma Consecutive 377 Cases (ID 9022)
09:30 - 16:00 | Author(s): S. Hasegawa
- Abstract
Background:
Video-assisted thoracic surgery (VATS) pleural biopsy is a most reliable diagnostic procedure for malignant pleural mesothelioma (MPM), however, its surgical outcomes are still unknown. The purpose of this study was to analyze the surgical outcome of VATS pleural biopsy in patients suspected of MPM.
Method:
A total of 377 patients received VATS pleural biopsy with suspected of MPM from March 2004 to December 2016 were included in the study. We evaluated their surgical outcome based on diagnostic accuracy, mortality, morbidity.
Result:
Of 377 patients, VATS pleural biopsy led to diagnosis as MPM in 250, carcinomatous pleurisy in 22 and chronic pleuritis in 105. However, of these 105 chronic pleuritis patients, 10 patients were received re-biopsy to establish the definitive diagnosis. Re-biopsy revealed 9 patients finally diagnosed as MPM, and 1 patient as carcinomatous pleurisy. The diagnostic accuracy of initial VATS pleural biopsy for MPM was 96.5% (250/259). The causes of miss-diagnosis were sampling error in all 9 cases, and the causes of sampling error as follows: no visible tumor in 4, complicated empyema in 2, severe adhesion in 2, and desmoplastic MPM in 1. The median postoperative stay was 5 days (1-114).Postoperative complication. Median age was 68 years (range, 40-85 years), with a 5- day (range 1-114 days) median length of stay. Postoperative complication occurred in 25 patients (5.7%), and 1 patient (0.26%) died due to postoperative empyema. Complications of this study included the following: injury of lung parenchyma in 7, wound infection in 4, re-expanding pulmonary edema in 3, empyema, gastrointestinal perforation and delirium in 2, fetal arrhythmia, cholecystitis hemothorax, liver dysfunction, acute respiratory failure in 1.
Conclusion:
VATS pleural biopsy could lead to definitive diagnosis in most case of MPM, but we should consider their limitation of diagnostic ability and the risk of VATS biopsy.
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P3.09 - Mesothelioma (ID 725)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.09-009 - Fourteen Cases Study of 5 Year Survivors of Malignant Pleural Mesothelioma Following Extrapleural Pneumonectomy (ID 9917)
09:30 - 16:00 | Author(s): S. Hasegawa
- Abstract
Background:
We performed extrapleural pneumonectomy (EPP) as curative intent surgery for malignant pleural mesothelioma (MPM) from 2004 to 2012. We investigated that factors associated with long term survival in our current cases.
Method:
We retrospectively reviewed some factors concerning the patients underwent EPP from April 2004 to march 2017 and past more than 5 years after operation. We analyzed age, sex, epidemiology, side, clinical stage, measurements of pleural thickness, the value of SUV max of PET-CT, pathological stage, length from EPP to recurrence and end results.
Result:
A total of 54 patients were enrolled to this study. Six patients who had exploratory thoracotomy and three patients who had not macroscopic complete resection were excluded. Overall, 14 patients (31%) survived at least 5 years (Group S), and 31 patients (68%) survived less than 5 years (Group N). All patients had EPP. In Group S, 10 males (71%) and 4 females (29%); age when they had operation ranged from 37 to 69 years with a median age of 57.5 years. All of them, histological subtypes were epithelial type. By the comparison between Group S and Group N, there were significant differences among the value of SUV max of PET-CT validation of pre and post neoadjvant chemotherapy(＜3.0 vs ≧3.0, p=0.03), length from EPP to radiotherapy (＜60 days vs ≧60 days, p=0.02), length from EPP to recurrence (＜1 year vs ≧1 year, p=0.0001).
Conclusion:
More than 30% patients survived at least 5 years in this study. One patient survived more than 10 years. Another patient survived more than 8 years without recurrence. This case suggest that cancer of the patient possibly cured radically. In the future, we need comparison the prognosis, complication, quality of life (QOL) between the patients who underwent EPP and the patients who underwent pleurectomy/decortications (P/D).
