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Rohit Lal
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P2.06 - Mesothelioma (ID 170)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Mesothelioma
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.06-05 - Multimodality Therapy Using Total Pleurectomy in Malignant Pleural Mesothelioma: Long-Term Outcomes in 150 Consecutive Cases (Now Available) (ID 1441)
10:15 - 18:15 | Author(s): Rohit Lal
- Abstract
Background
We wished to evaluate the long-term outcomes of patients receiving multimodality therapy including total pleurectomy/decortication, radiotherapy and systemic chemotherapy for malignant pleural mesothelioma.
Method
Retrospective analysis of patients treated between September 2004 and April 2019 by a specialised thoracic multidisciplinary team. Treatment involved total pleurectomy and decortication of lung, prophylactic radiotherapy (21 Gy in 3 fractions) and systemic chemotherapy based on pemetrexed and platinum. PET-CT was used routinely to diagnose disease recurrence or progression. Second or third-line therapies were administered when appropriate. Survival and prognostic factors were analysed by the Kaplan-Meier method and Cox regression analysis.
Result
150 patients had multimodality therapy over a 15-year period. Median age at operation was 62 years (range 32-82) and the male/female ratio was 122/28. Thirty-one patients (20.6%) had received chemotherapy before surgery. Thirty-three patients (22%) had extended resections. Sixty-two patients suffered a postoperative complication and 90-day mortality was nil. Eleven patients (7.3%) had reoperation within 30 days. Histological types were epithelioid in 105 patients and non-epithelioid in 45. Pathological stages were: I:86, II: 9, III: 54, and IV:1 (8th TNM classification). All patients but one received prophylactic radiotherapy. Six patients (4%) did not received systemic chemotherapy. Sixty-five patients (43.3%) received second-line or further systemic therapies. Five patients received stereotactic radiotherapy and three patients had late reoperation for focal tumour recurrence. Median survival was 30.5 months overall (95% CI 25.4-35.6), 34 months for epithelioid type (95% CI 25.8-42.2) and 18.3 months for non-epithelioid type (95% CI 14.2-22.4). Histological type and macroscopic complete resection were predictive of extended survival in our analysis.
Conclusion
Total Pleurectomy /Decortication is a safe and well-tolerated procedure associated with no mortality and acceptable morbidity. Most patients can receive prophylactic radiotherapy and systemic chemotherapy in due time. Many can receive second-line or further therapy on progression, resulting in prolonged survival.
