INTRAARTERIAL PERFUSION OF DIFFUSE PLEURA L MESOTHELIOMA - AN ALTERNATIVE MANAGEMENT FOR INOPERABLE CASES

Background: The prognosis of diffuse pleural mesothelioma remains unfa vourable, with or without therapy. And no curative approach has been e stablished to date. At present, tumour decortication involving pleurec tomy is the therapy of choice for younger patients at a favourable sta ge of tumour formation and histology. The role of oncological therapy for patients with inoperable progression of the disease is unsatisfact ory and still subject to controversial discussion. Patient and Method: We report on a management concept combining radiation and direct intr a-arterial perfusion of cisplatin and mitoxantrone for primary inopera ble pleural mesothelioma showing diffuse growth at an advanced stage a nd on the clinical progression. In the course of treatment the truncus costobronchialis and the 5th ot 12th intercostal artery of the left h emithorax were selected with various frequencies and used for chemothe rapy. Result: Management consisted of 11 intra-arterial perfusions of the left hemithorax using mitoxantrone and cisplatin, accompanied by r adiation with a total focal dosage of 46 Gy (Linac). Due to this thera py regime the patient survived for 28 months, enjoying a good quality of life. Conclusion: The case reported suggests that such a therapy ap proach combining intra-arterial, direct perfusion with radiotherapy fo r the management of pronounced and irreversible manifestations of pleu ral mesothelioma (stage IV) is effective even from a palliative point of view. Thus we consider it highly recommendable as compared to alter native therapies, regarding the resultant quality of life and life exp ectancy.