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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
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
P2.06-17 - The Results of Tri-Modality Treatment with Extrapleural Pneumonectomy, Radiation, and Chemotherapy for Malignant Pleural Mesothelioma (Now Available) (ID 408)
10:15 - 18:15 | Presenting Author(s): Kazunori Okabe
Extrapleural pneumonectomy (EPP) or Pleurectomy/Decortication (P/D) is performed for operable malignant pleural mesothelioma (MPM). International Mesothelioma Interest Group (IMIG) guidelines (Rusch V, et al. JTCVS 2013) concluded that EPP or P/D should be selected on the basis of disease distribution, institutional experience, and surgeon preference and experience. Our first choice is EPP followed by radiation and chemotherapy. If EPP is inappropriate, P/D followed by chemotherapy is performed. Our improving results of tri-modality treatment strategy to treat MPM by EPP are reported.Method
58 consecutive EPP for MPM from June 2006 to January 2019 in our hospital were reviewed. We have instituted a trimodality therapy protocol consisting of EPP, adjuvant 45-50.4 Gy hemithoracic radiation, and adjuvant CDDP plus PEM chemotherapy. 48 patients were treated with this protocol. However, 10 patients were given induction chemotherapy, and referred to us. They were scheduled to undergo EPP and adjuvant radiation. Overall survival from the treatment start was calculated using Kaplan-Meier method. The prognosis data were updated in February 2019.Result
Median age at EPP was 62 years old (39-74). Female was 11, and male was 47. Right side was 30, and left side was 28. Epithelioid was 39 (67%), biphasic was 14, sarcomatoid was 2, and special variants was 3. Median EPP time was 7 hours 33 minutes (5 h 50 m-12 h 2 m). No blood transfusion during EPP was 20 cases (34%). Mortality was one patient (1.7%) who died due to acute aggravation of interstitial pneumonia. Atrial fibrillation was the most common morbidity, and developed in 20 patients (34%). IMIG pathological stage was IV in 6, III in 31, II in 13, and Ib in 8. Adjuvant 45-50.4 Gy radiation was completed for 49 patients (84%). 11 of 54 patients (20%) could not undergo chemotherapy, and four patients are waiting for chemotherapy. 37 of 54 patients (69%) underwent trimodality therapy, and 4 patients are waiting for chemotherapy. Postoperative median follow-up period was 6 years and 7 months. 5 year survival, 2 year survival, and median survival of all 58 patients were 27%, 53%, and 30 months, and those of 39 epithelioid patients were 32%, 63%, and 37 months, and those of recent 29 epithelioid patients from 2011 were 43%, 72%, and 59 months (Figure)..Conclusion
This tri-modality treatment strategy with EPP, radiation, and chemotherapy for MPM is feasible, and the prognosis has been greatly improved.
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