MULTIMODALITY THERAPY FOR MALIGNANT PLEURAL MESOTHELIOMA

Mesothelioma is a rare disease for which neither single modality nor b imodality therapy improves survival. For this reason, from 1980 to 199 5, we used trimodality therapy in an attempt to improve survival in se lected patients at Brigham and Women's Hospital and Dana-Farber Cancer Institute, One hundred twenty patients underwent trimodality treatmen t involving extrapleural pneumonectomy followed by combination chemora diotherapy, Twenty-seven women and 93 men (mean age, 56 years) were ev aluable for response and treatment-related morbidity. The operative mo rtality rate was 5%, and 22% of patients experienced major morbidity, Cell type and nodal status were significant prognostic variables, The respective 2- and 5-year survival rates were 45% and 22% overall, 70% and 37% for patients with epithelial cell type, 20% and 0% for patient s with sarcomatous or mixed-histologic-type tumors, and 74% and 39% fo r patients who were node-negative with epithelial histologic type. Pos itive resection margins impacted survival only in the case of full-thi ckness, transdiaphragmatic invasion. A revised staging system stratifi ed survival with median intervals of 22, 17, and 11 months for stages I, II, and III disease, respectively (p=0.04). Thus, extrapleural pneu monectomy with adjuvant therapy is appropriate and effective treatment for patients with stage I disease according to the revised staging sy stem.