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
Thoracic Surgery Unit, Department of Translational Medicine, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
Medical Oncology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
Cancers (Basel). 2021 Dec 29;14(1):142. doi: 10.3390/cancers14010142.
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.
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.
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.
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.
多模式治疗被认为是恶性胸膜间皮瘤（MPM）的最佳治疗策略。然而，它们的理想组合仍存在争议。在此，我们报告一组采用三联模式治疗的MPM病例：诱导化疗（CT）、胸膜剥脱术/去皮质术（P/D）、术后放疗（RT）和术后CT。
回顾性分析2013年至2020年间治疗的17例MPM患者的病例系列。患者经电视辅助胸腔镜诊断为上皮型或混合型MPM，病理分期为IMIG I期或II期。收集治疗细节和放射学数据。诱导治疗由顺铂和培美曲塞联合组成，每21天为一个周期，共两个周期。诱导CT后4 - 6周进行P/D，手术后3 - 6周进行术后放疗，而术后CT在放疗后4 - 6周进行，诱导方案相同。
所有患者在诱导CT后的重新分期时均显示疾病客观缓解或稳定，并通过后外侧开胸手术。术中主要并发症有2例心脏骤停，均通过胸外心脏按压解决。次要并发症包括1例半膈肌抬高、1例需要输血的贫血、1例伤口感染和2例持续性气胸。中位总生存期为32.1个月，中位无进展生存期为23.7个月。
这些结果表明该三联模式治疗方案对早期MPM患者具有可行性。需要更大规模的系列研究和长期前瞻性研究来证实该策略的有效性。
