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Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach

BACKGROUND: The exact role and type of surgery for malignant pleural mesothelioma (MPM) remains controversial. This study aimed at analyzing a 20-year single center perioperative experience in MPM surgery at our high-volume thoracic surgery center and comparing the overall survival after trimodal ex...

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Autores principales: Klotz, Laura V., Hoffmann, Hans, Shah, Rajiv, Eichhorn, Florian, Gruenewald, Christiane, Bulut, Elena L., Griffo, Raffaella, Muley, Thomas, Christopoulos, Petros, Baum, Philip, Huber, Peter, Safi, Seyer, Kriegsmann, Marc, Thomas, Michael, Bischoff, Helge, Winter, Hauke, Eichhorn, Martin E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9742626/
https://www.ncbi.nlm.nih.gov/pubmed/36519024
http://dx.doi.org/10.21037/tlcr-22-199
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author Klotz, Laura V.
Hoffmann, Hans
Shah, Rajiv
Eichhorn, Florian
Gruenewald, Christiane
Bulut, Elena L.
Griffo, Raffaella
Muley, Thomas
Christopoulos, Petros
Baum, Philip
Huber, Peter
Safi, Seyer
Kriegsmann, Marc
Thomas, Michael
Bischoff, Helge
Winter, Hauke
Eichhorn, Martin E.
author_facet Klotz, Laura V.
Hoffmann, Hans
Shah, Rajiv
Eichhorn, Florian
Gruenewald, Christiane
Bulut, Elena L.
Griffo, Raffaella
Muley, Thomas
Christopoulos, Petros
Baum, Philip
Huber, Peter
Safi, Seyer
Kriegsmann, Marc
Thomas, Michael
Bischoff, Helge
Winter, Hauke
Eichhorn, Martin E.
author_sort Klotz, Laura V.
collection PubMed
description BACKGROUND: The exact role and type of surgery for malignant pleural mesothelioma (MPM) remains controversial. This study aimed at analyzing a 20-year single center perioperative experience in MPM surgery at our high-volume thoracic surgery center and comparing the overall survival after trimodal extrapleural pneumonectomy (EPP) and extended pleurectomy and decortication combined with hyperthermic intrathoracic chemoperfusion (EPD/HITOC) and adjuvant chemotherapy with that after chemotherapy (CTx) alone. METHODS: Patients with epithelioid MPM treated with neoadjuvant chemotherapy, EPP and adjuvant radiotherapy within a trimodal concept or EPD/HITOC in combination with adjuvant chemotherapy between 2001 and 2018 were included in this retrospective analysis. Surgical cohorts were compared to patients treated with standard chemotherapy. RESULTS: Overall, 182 patients (69 EPP, 57 EPD/HITOC, 56 CTx) were analyzed. Due to occupational exposure to asbestos for most of the patients, 154 patients (84.6%) were male. The patients in the surgical cohorts were significantly younger than those in the CTx cohort. There was no significant difference between the proportion of patient age and side. The median overall survival of the EPD/HITOC cohort with 38.1 months was significantly longer than that of the EPP and CTx cohorts (24.0 and 15.8 months). Better survival was significantly associated with an ECOG 0 performance status, age below 70 years, and negative lymph node status. In the multivariate analysis, EPD/HITOC was significantly associated with improved overall survival. Perioperative morbidity was lower in the EPD/HITOC group than in the EPP cohort. CONCLUSIONS: EPD/HITOC is feasible and safe for localized epithelioid pleural mesothelioma. Changing the surgical approach to a less radical lung-sparing technique may improve overall survival compared to trimodal EPP.
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spelling pubmed-97426262022-12-13 Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach Klotz, Laura V. Hoffmann, Hans Shah, Rajiv Eichhorn, Florian Gruenewald, Christiane Bulut, Elena L. Griffo, Raffaella Muley, Thomas Christopoulos, Petros Baum, Philip Huber, Peter Safi, Seyer Kriegsmann, Marc Thomas, Michael Bischoff, Helge Winter, Hauke Eichhorn, Martin E. Transl Lung Cancer Res Original Article BACKGROUND: The exact role and type of surgery for malignant pleural mesothelioma (MPM) remains controversial. This study aimed at analyzing a 20-year single center perioperative experience in MPM surgery at our high-volume thoracic surgery center and comparing the overall survival after trimodal extrapleural pneumonectomy (EPP) and extended pleurectomy and decortication combined with hyperthermic intrathoracic chemoperfusion (EPD/HITOC) and adjuvant chemotherapy with that after chemotherapy (CTx) alone. METHODS: Patients with epithelioid MPM treated with neoadjuvant chemotherapy, EPP and adjuvant radiotherapy within a trimodal concept or EPD/HITOC in combination with adjuvant chemotherapy between 2001 and 2018 were included in this retrospective analysis. Surgical cohorts were compared to patients treated with standard chemotherapy. RESULTS: Overall, 182 patients (69 EPP, 57 EPD/HITOC, 56 CTx) were analyzed. Due to occupational exposure to asbestos for most of the patients, 154 patients (84.6%) were male. The patients in the surgical cohorts were significantly younger than those in the CTx cohort. There was no significant difference between the proportion of patient age and side. The median overall survival of the EPD/HITOC cohort with 38.1 months was significantly longer than that of the EPP and CTx cohorts (24.0 and 15.8 months). Better survival was significantly associated with an ECOG 0 performance status, age below 70 years, and negative lymph node status. In the multivariate analysis, EPD/HITOC was significantly associated with improved overall survival. Perioperative morbidity was lower in the EPD/HITOC group than in the EPP cohort. CONCLUSIONS: EPD/HITOC is feasible and safe for localized epithelioid pleural mesothelioma. Changing the surgical approach to a less radical lung-sparing technique may improve overall survival compared to trimodal EPP. AME Publishing Company 2022-11 /pmc/articles/PMC9742626/ /pubmed/36519024 http://dx.doi.org/10.21037/tlcr-22-199 Text en 2022 Translational Lung Cancer Research. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Klotz, Laura V.
Hoffmann, Hans
Shah, Rajiv
Eichhorn, Florian
Gruenewald, Christiane
Bulut, Elena L.
Griffo, Raffaella
Muley, Thomas
Christopoulos, Petros
Baum, Philip
Huber, Peter
Safi, Seyer
Kriegsmann, Marc
Thomas, Michael
Bischoff, Helge
Winter, Hauke
Eichhorn, Martin E.
Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach
title Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach
title_full Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach
title_fullStr Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach
title_full_unstemmed Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach
title_short Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach
title_sort multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9742626/
https://www.ncbi.nlm.nih.gov/pubmed/36519024
http://dx.doi.org/10.21037/tlcr-22-199
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