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A Trimodality, Four-Step Treatment including Chemotherapy, Pleurectomy/Decortication and Radiotherapy in Early-Stage Malignant Pleural Mesothelioma: A Single-Institution Retrospective Case Series Study

SIMPLE SUMMARY: Multimodality treatment can improve outcome of malignant pleural mesothelioma (MPM) patients. However, the ideal scheme of combination of them is still unknown. We analyzed a case series of 17 patients treated at our institution with a sequence of induction chemotherapy, surgery, adj...

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Autores principales: Vicidomini, Giovanni, Della Corte, Carminia Maria, Noro, Antonio, Di Liello, Raimondo, Cappabianca, Salvatore, Fiorelli, Alfonso, Nardone, Valerio, Messina, Gaetana, Viscardi, Giuseppe, Sangiovanni, Angelo, Monti, Riccardo, Accardo, Marina, Morgillo, Floriana, Ciardiello, Fortunato, Franco, Renato, Santini, Mario
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8749971/
https://www.ncbi.nlm.nih.gov/pubmed/35008306
http://dx.doi.org/10.3390/cancers14010142
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author Vicidomini, Giovanni
Della Corte, Carminia Maria
Noro, Antonio
Di Liello, Raimondo
Cappabianca, Salvatore
Fiorelli, Alfonso
Nardone, Valerio
Messina, Gaetana
Viscardi, Giuseppe
Sangiovanni, Angelo
Monti, Riccardo
Accardo, Marina
Morgillo, Floriana
Ciardiello, Fortunato
Franco, Renato
Santini, Mario
author_facet Vicidomini, Giovanni
Della Corte, Carminia Maria
Noro, Antonio
Di Liello, Raimondo
Cappabianca, Salvatore
Fiorelli, Alfonso
Nardone, Valerio
Messina, Gaetana
Viscardi, Giuseppe
Sangiovanni, Angelo
Monti, Riccardo
Accardo, Marina
Morgillo, Floriana
Ciardiello, Fortunato
Franco, Renato
Santini, Mario
author_sort Vicidomini, Giovanni
collection PubMed
description SIMPLE SUMMARY: Multimodality treatment can improve outcome of malignant pleural mesothelioma (MPM) patients. However, the ideal scheme of combination of them is still unknown. We analyzed a case series of 17 patients treated at our institution with a sequence of induction chemotherapy, surgery, adjuvant radiotherapy and chemotherapy. Median overall survival was 32.1 months, median progression free survival was 23.7 months with a safe profile. These data according to our experience represent a great example of feasibility in clinical practice of three-modality four step approach and encourage further prospective studies to better define the details of treatment. ABSTRACT: Background: Multimodality treatment is considered the best treatment strategy for malignant pleural mesothelioma (MPM). However, the ideal combination of them is still a matter of controversy. Here, we report a case series of MPM treated with a trimodality approach: induction chemotherapy (CT), pleurectomy/decortication (P/D), postoperative radiotherapy (RT) and post-operative CT. Methods: A retrospective case series of 17 MPM patients treated between 2013 and 2020 is presented. Patients had epithelial or mixed MPM diagnosed by video-assisted thoracoscopy and pathologic IMIG stage I or II disease. Treatment details and radiological data were collected. Induction therapy consisted of combination of cisplatin and pemetrexed, every 21 days for two cycles. P/D was performed 4–6 weeks after induction CT, post-operative RT 3–6 weeks after surgery, while post-operative CT was given 4–6 weeks after RT, with the same schedule of induction. Results: All patients showed objective response or stability of disease at the restaging following induction CT and underwent surgery by posterolateral thoracotomy. There were two cases of cardiac arrest as major intraoperative complication, both resolved by manual cardiac massage. Minor complications included one hemidiaphragm elevation, 1 anemia requiring blood transfusion, one wound infection, and two persistent air leaks. Median overall survival was 32.1 months, median progression free survival was 23.7 months. Conclusions: These results suggest the feasibility of these trimodality treatment scheme for early stage MPM patients. Larger series and long-term prospective studies are needed to confirm the validity of this strategy.
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spelling pubmed-87499712022-01-12 A Trimodality, Four-Step Treatment including Chemotherapy, Pleurectomy/Decortication and Radiotherapy in Early-Stage Malignant Pleural Mesothelioma: A Single-Institution Retrospective Case Series Study Vicidomini, Giovanni Della Corte, Carminia Maria Noro, Antonio Di Liello, Raimondo Cappabianca, Salvatore Fiorelli, Alfonso Nardone, Valerio Messina, Gaetana Viscardi, Giuseppe Sangiovanni, Angelo Monti, Riccardo Accardo, Marina Morgillo, Floriana Ciardiello, Fortunato Franco, Renato Santini, Mario Cancers (Basel) Article SIMPLE SUMMARY: Multimodality treatment can improve outcome of malignant pleural mesothelioma (MPM) patients. However, the ideal scheme of combination of them is still unknown. We analyzed a case series of 17 patients treated at our institution with a sequence of induction chemotherapy, surgery, adjuvant radiotherapy and chemotherapy. Median overall survival was 32.1 months, median progression free survival was 23.7 months with a safe profile. These data according to our experience represent a great example of feasibility in clinical practice of three-modality four step approach and encourage further prospective studies to better define the details of treatment. ABSTRACT: Background: Multimodality treatment is considered the best treatment strategy for malignant pleural mesothelioma (MPM). However, the ideal combination of them is still a matter of controversy. Here, we report a case series of MPM treated with a trimodality approach: induction chemotherapy (CT), pleurectomy/decortication (P/D), postoperative radiotherapy (RT) and post-operative CT. Methods: A retrospective case series of 17 MPM patients treated between 2013 and 2020 is presented. Patients had epithelial or mixed MPM diagnosed by video-assisted thoracoscopy and pathologic IMIG stage I or II disease. Treatment details and radiological data were collected. Induction therapy consisted of combination of cisplatin and pemetrexed, every 21 days for two cycles. P/D was performed 4–6 weeks after induction CT, post-operative RT 3–6 weeks after surgery, while post-operative CT was given 4–6 weeks after RT, with the same schedule of induction. Results: All patients showed objective response or stability of disease at the restaging following induction CT and underwent surgery by posterolateral thoracotomy. There were two cases of cardiac arrest as major intraoperative complication, both resolved by manual cardiac massage. Minor complications included one hemidiaphragm elevation, 1 anemia requiring blood transfusion, one wound infection, and two persistent air leaks. Median overall survival was 32.1 months, median progression free survival was 23.7 months. Conclusions: These results suggest the feasibility of these trimodality treatment scheme for early stage MPM patients. Larger series and long-term prospective studies are needed to confirm the validity of this strategy. MDPI 2021-12-29 /pmc/articles/PMC8749971/ /pubmed/35008306 http://dx.doi.org/10.3390/cancers14010142 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Vicidomini, Giovanni
Della Corte, Carminia Maria
Noro, Antonio
Di Liello, Raimondo
Cappabianca, Salvatore
Fiorelli, Alfonso
Nardone, Valerio
Messina, Gaetana
Viscardi, Giuseppe
Sangiovanni, Angelo
Monti, Riccardo
Accardo, Marina
Morgillo, Floriana
Ciardiello, Fortunato
Franco, Renato
Santini, Mario
A Trimodality, Four-Step Treatment including Chemotherapy, Pleurectomy/Decortication and Radiotherapy in Early-Stage Malignant Pleural Mesothelioma: A Single-Institution Retrospective Case Series Study
title A Trimodality, Four-Step Treatment including Chemotherapy, Pleurectomy/Decortication and Radiotherapy in Early-Stage Malignant Pleural Mesothelioma: A Single-Institution Retrospective Case Series Study
title_full A Trimodality, Four-Step Treatment including Chemotherapy, Pleurectomy/Decortication and Radiotherapy in Early-Stage Malignant Pleural Mesothelioma: A Single-Institution Retrospective Case Series Study
title_fullStr A Trimodality, Four-Step Treatment including Chemotherapy, Pleurectomy/Decortication and Radiotherapy in Early-Stage Malignant Pleural Mesothelioma: A Single-Institution Retrospective Case Series Study
title_full_unstemmed A Trimodality, Four-Step Treatment including Chemotherapy, Pleurectomy/Decortication and Radiotherapy in Early-Stage Malignant Pleural Mesothelioma: A Single-Institution Retrospective Case Series Study
title_short A Trimodality, Four-Step Treatment including Chemotherapy, Pleurectomy/Decortication and Radiotherapy in Early-Stage Malignant Pleural Mesothelioma: A Single-Institution Retrospective Case Series Study
title_sort trimodality, four-step treatment including chemotherapy, pleurectomy/decortication and radiotherapy in early-stage malignant pleural mesothelioma: a single-institution retrospective case series study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8749971/
https://www.ncbi.nlm.nih.gov/pubmed/35008306
http://dx.doi.org/10.3390/cancers14010142
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