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Annals of Oncology Advance Access originally published online on April 11, 2007
Annals of Oncology 2007 18(7):1196-1202; doi:10.1093/annonc/mdm093
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© 2007 European Society for Medical Oncology

lung cancer

Multicenter trial of neo-adjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma

W Weder1,{dagger}, RA Stahel2,*,{dagger}, J Bernhard3,8, S Bodis4, P Vogt5, P Ballabeni3, D Lardinois6, D Betticher7, R Schmid8, R Stupp9, HB Ris10, M Jermann2, W Mingrone11, AD Roth12, A Spiliopoulos13 On behalf of the Swiss Group for Clinical Cancer Research

1 Department of Thoracic Surgery
2 Clinic and Poliklinik for Oncology, University Hospital, University Hospital Zurich, Zurich
3 Swiss Group for Clinical Cancer Research (SAKK), Bern
4 Institute for Radio-Oncology, Kantonsspital Aarau, Aarau
5 Institute of Pathology
6 Department of Thoracic Surgery, University Hospital, University Hospital Zurich, Zurich
7 Department of Medicine, Hospital of Fribourg, Fribourg
8 Clinic and Policlinic for Thoracic Surgery, Inselspital Bern, Bern
9 Centre Pluridisciplinaire d'Oncologie
10 Service de chirurgie thoracique, Centre Hospitalier Universitaire Vaudois, Lausanne
11 Zentrum für Onkologie, Kantonsspital Aarau, Aarau
12 Département de Chirurgie Oncochirurgie
13 Unité Chirurgie Thorac, University Hospital Geneva, Genève, Switzerland

* Correspondence to: Dr R. A. Stahel, Clinic and Policlinic of Oncology, University Hospital, CH-8091 Zurich, Switzerland. Tel: +41-44-634-2871; Fax: +41-44-634-2872; E-mail: rolf.stahel{at}usz.ch

Background: The aim of this multicenter trial was to prospectively evaluate neo-adjuvant chemotherapy followed by extrapleural pneumonectomy (EPP) and radiotherapy, including quality of life as outcome.

Patients and methods: Eligible patients had malignant pleural mesothelioma of all histological types, World Health Organization performance status of zero to two and clinical stage T1–T3, N0–2, M0 disease considered completely resectable. Neo-adjuvant chemotherapy consisted of three cycles of cisplatin and gemcitabine followed by EPP. Postoperative radiotherapy was considered for all patients.

Results: In all, 58 of 61 patients completed three cycles of neo-adjuvant chemotherapy. Forty-five patients (74%) underwent EPP and in 37 patients (61%) the resection was complete. Postoperative radiotherapy was initiated in 36 patients. The median survival of all patients was 19.8 months [95% confidence interval (CI) 14.6–24.5]. For the 45 patients undergoing EPP, the median survival was 23 months (95% CI 16.6–32.9). Psychological distress showed minor variations over time with distress above the cut-off score indicating no morbidity with 82% (N = 36) at baseline and 76% (N = 26) at 3 months after surgery (P = 0.5).

Conclusions: The observed rate of operability is promising. A median survival of 23 months for patients undergoing EPP compares favourably with the survival reported from single center studies of upfront surgery. This approach was not associated with an increase in psychological distress.

Key words: extrapleural pneumonectomy, malignant pleural mesothelioma, neo-adjuvant chemotherapy, quality of life

{dagger} Both authors contributed equally to this manuscript.

Received for publication September 25, 2006. Revision received February 11, 2007. Accepted for publication February 14, 2007.


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