de Perrot Marc, Feld Ronald, Cho B C John, Bezjak Andrea, Anraku Masaki, Burkes Ronald, Roberts Heidi, Tsao Ming S, Leighl Natasha, Keshavjee Shaf, Johnston Michael R
Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
J Clin Oncol. 2009 Mar 20;27(9):1413-8. doi: 10.1200/JCO.2008.17.5604. Epub 2009 Feb 17.
Malignant pleural mesothelioma (MPM) remains associated with poor outcome. We examined the results of trimodality therapy with cisplatin-based chemotherapy followed by extrapleural pneumonectomy (EPP) and adjuvant high-dose (50 to 60 Gy) hemithoracic radiation therapy for MPM.
We conducted a retrospective review of all patients prospectively evaluated for trimodality therapy protocol between January 2001 and December 2007 in our institution.
A total of 60 patients were suitable candidates. Histology was epithelioid (n = 44) or biphasic (n = 16). Chemotherapy regimens included cisplatin/vinorelbine (n = 26), cisplatin/pemetrexed (n = 24), cisplatin/raltitrexed (n = 6), or cisplatin/gemcitabine (n = 4). EPP was performed in 45 patients, and hemithoracic radiation therapy to at least 50 Gy was administered postoperatively to 30 patients. Completion of the trimodality therapy in the absence of mediastinal node involvement was associated with the best survival (median survival of 59 months v <or= 14 months in the remaining patients, P = .0003). The type of induction chemotherapy had no significant impact on survival. Pathologic nodal status remained a significant predictor of poor survival despite completion of the trimodality therapy. After completion of the protocol, the 5-year disease-free survival was 53% for patients with N0 disease, reaching 75% in patients with ypT1-2N0 and 45% in patients with ypT3-4N0.
This large, single-center experience with induction chemotherapy followed by EPP and adjuvant high-dose hemithoracic radiation for MPM shows that half of the patients are able to complete this protocol. The results are encouraging for patients with N0 disease. However, N2 disease remains a major factor impacting on survival, despite completion of the entire trimodality regimen.
恶性胸膜间皮瘤（MPM）的预后仍然较差。我们研究了以顺铂为基础的化疗，随后行胸膜外全肺切除术（EPP）及辅助大剂量（50至60 Gy）半胸放疗用于MPM的三联疗法的结果。
我们对2001年1月至2007年12月在本机构前瞻性评估三联疗法方案的所有患者进行了回顾性分析。
共有60例患者为合适的候选对象。组织学类型为上皮样（n = 44）或双向性（n = 16）。化疗方案包括顺铂/长春瑞滨（n = 26）、顺铂/培美曲塞（n = 24）、顺铂/雷替曲塞（n = 6）或顺铂/吉西他滨（n = 4）。45例患者接受了EPP，30例患者术后接受了至少50 Gy的半胸放疗。在无纵隔淋巴结受累的情况下完成三联疗法与最佳生存相关（中位生存期为59个月，其余患者中位生存期≤14个月，P = 0.0003）。诱导化疗的类型对生存无显著影响。尽管完成了三联疗法，但病理淋巴结状态仍然是生存不良的重要预测因素。完成方案后，N0疾病患者的5年无病生存率为53%，ypT1 - 2N0患者达到75%，ypT3 - 4N0患者为45%。
这项针对MPM先进行诱导化疗，然后行EPP及辅助大剂量半胸放疗的大型单中心经验表明，一半的患者能够完成该方案。结果对N0疾病患者令人鼓舞。然而，尽管完成了整个三联疗法方案，N2疾病仍然是影响生存的主要因素。
