Chest
Multimodality Therapy for Malignant Pleural Mesothelioma
Section snippets
Materials and Methods
Thus, in our study, candidate patients were evaluated on the basis of spirometry, oximetry, arterial blood gases, chest radiograph and CT, chest MRI (after 1988), ventilation-perfusion scan (if FEV1 was <1 L), and echocardiography. Patients without medical contraindications whose tumor was clinical stage I according to Butchart et al14 and considered completely resectable were candidates for trimodality therapy if they had an Eastern Cooperative Oncology Group performance status of 0 or 1 and
Results
Median length of hospital stay following extrapleural pneumonectomy was 9 days (range, 5 to 101 days). Perioperative (30-day) mortality was 5%, resulting from myocardial infarction (two patients), pulmonary embolus (two), respiratory failure (one), and cardiac herniation through the pericardial defect (one). Morbidity was 22%. Fifteen patients (12.5%) experienced one or more of the following major complications: hemorrhage (four patients), respiratory failure (four), pneumonia (five), disrupted
Discussion
In appropriately selected patients, extrapleural pneumonectomy with adjuvant chemotherapy and radiotherapy is safe and effective treatment for malignant pleural mesothelioma. Overall median survival (21 months, Fig 1) of patients receiving this trimodality therapy is superior to that obtained with single-modality therapy. Nodal involvement, cell type, and transdiaphragmatic invasion are prognostic factors that stratify survival of patients treated in this manner. The results described herein
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Reprint requests: David J. Sugarbaker, MD, FCCP, Division of Thoracic Surgery, Brigham and Womens Hospital, 75 Francis St, Boston, MA 02115