Rea Federico, Marulli Giuseppe, Bortolotti Luigi, Breda Cristiano, Favaretto Adolfo Gino, Loreggian Lucio, Sartori Francesco
Division of Thoracic Surgery, University of Padua, Policlinico di Padova, Italy.
Lung Cancer. 2007 Jul;57(1):89-95. doi: 10.1016/j.lungcan.2007.02.004. Epub 2007 Apr 2.
Trimodality therapy seems to be the best treatment for malignant pleural mesothelioma (MPM). A large experience served to evaluate the efficacy of surgery followed by adjuvant chemo-radiotherapy. Trimodality therapy results have led us to test induction chemotherapy followed by EPP and adjuvant radiotherapy in stages I-III of MPM. The aim of our study was to evaluate the feasibility of this protocol and to estimate survival.
From 2000 to 2003, 21 patients with MPM (14 males and 7 females, median age 59 years) were enrolled in the prospective study. Induction chemotherapy consisted of Carboplatin (AUC 5mg/mL/min on Day 1) and Gemcitabine (1000mg/m(2) on Days 1, 8, 15) for three to four cycles. EPP was performed 3-5 weeks after induction therapy, while post-operative RT was given 4-6 weeks after operation.
Ten patients received three cycles of chemotherapy, 10 patients received four cycles and 1 patient had two cycles. Grades 3-4 haematological toxicity occurred in eight (38.1%) patients. Chemotherapy response rate was: complete 0%, partial 33.3% and stable disease 66.7%. Seventeen (80.9%) out of 21 patients underwent EPP with no intra or post-operative mortality with an overall major and minor morbidity rate at 52.4%. Median survival was 25.5 months, with an overall 1, 3 and 5-year survival rate of 71, 33 and 19%, respectively.
In MPM, the combined modality approach using the Carboplatin/Gemcitabine combination as induction chemotherapy is feasible, with good results in terms of survival and morbidity. Our results are similar to those of other studies using a heavier modality treatment.
三联疗法似乎是恶性胸膜间皮瘤（MPM）的最佳治疗方法。大量经验用于评估手术联合辅助放化疗的疗效。三联疗法的结果促使我们在MPM的I - III期测试诱导化疗，随后进行扩大性肺切除术（EPP）和辅助放疗。本研究的目的是评估该方案的可行性并估计生存率。
2000年至2003年，21例MPM患者（14例男性和7例女性，中位年龄59岁）纳入前瞻性研究。诱导化疗包括卡铂（第1天剂量为AUC 5mg/mL/min）和吉西他滨（第1、8、15天剂量为1000mg/m²），共三至四个周期。诱导治疗后3 - 5周进行EPP，术后放疗在术后4 - 6周进行。
10例患者接受了三个周期的化疗，10例患者接受了四个周期，1例患者接受了两个周期。8例（38.1%）患者出现3 - 4级血液学毒性。化疗缓解率为：完全缓解0%，部分缓解33.3%，疾病稳定66.7%。21例患者中有十七例（80.9%）接受了EPP，无术中或术后死亡，总体主要和次要发病率为52.4%。中位生存期为25.5个月，1年、3年和5年总生存率分别为71%、33%和19%。
在MPM中，使用卡铂/吉西他滨联合作为诱导化疗的综合治疗方法是可行的，在生存率和发病率方面取得了良好结果。我们的结果与其他采用更强化治疗方法的研究结果相似。
