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Epidemiology and outcomes (ID 57)
- Event: ELCC 2018
- Type: Poster Discussion session
- Presentations: 1
216PD - Should radical surgery be performed in non-epithelioid malignant pleural mesothelioma? (ID 508)
14:45 - 15:45 | Author(s): J. Spicer
Non-epithelioid malignant pleural mesothelioma (MPM) has a bad prognosis. We wished to evaluate the impact of multimodality therapy on survival in non-epithelioid MPM.
Analysis of a prospective database of MPM patients operated on since September 2004. All patients had extended pleurectomy/decortication (ePD) and hyperthermic povidone-iodine pleural lavage (HPL), prophylactic radiotherapy and systemic platinum-based chemotherapy. All patients were followed up until death. PET–CT was used routinely to monitor patients. Survival and prognostic factors were analysed by the Kaplan–Meier method, log–rank test and Cox regression analysis.
139 patients had ePD and HPL. Median age was 64 years and 80% of patients were male.17% of patients had received systemic chemotherapy prior to surgery. 90–day mortality was nil and 39.6% of patients experienced postoperative complications. 9 patients had reoperation within 30 days. Final histopathology showed epithelioid type in 96 patients and non–epithelioid type in 43. Staging (8th ed. TNM classification) was as follows: I, 7.2%; II, 24.4%, III, 54%, IV, 14.4%. Five patients did not receive adjuvant chemotherapy and 4 received less than 4 cycles in total. All other patients received 4–6 cycles of chemotherapy. All patients received prophylactic radiotherapy (21 Gy). 52% of patients received second–line therapies. Two patients had cyberknife therapy and 3 patients had late reoperations for focal relapse. Median follow–up is 50 months and 92 patients have died. Median overall survival is 35 months (95% CI 26.3–43.7) for epithelioid histology versus 18 months (95% CI 15.1–20.9) for non-epithelioid histology (p = 0.000037). Macroscopic complete resection and epithelioid histology are independent prognostic factors of long–term survival at multivariate analysis.
Multimodality therapy including ePD and HPL is safe and well-tolerated. Most patients can receive further therapies when disease progresses. Patients with epithelioid histology achieve prolonged survival. Patients with non-epithelioid histology have a modest survival benefit and radical surgery should be offered only to those with early-stage disease.
Clinical trial identification:
Legal entity responsible for the study:
Dr. Loic Lang-Lazdunski
Has not received any funding
All authors have declared no conflicts of interest.
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