PATTERNS OF FAILURE AFTER TRIMODALITY THERAPY FOR MALIGNANT PLEURAL MESOTHELIOMA

Background. Malignant pleural mesothelioma is uncommon, and presently, no standard treatment of this disease exists. The objective of our an alysis was to study the patterns of failure for malignant pleural meso thelioma after trimodality treatment consisting of extrapleural pneumo nectomy, chemotherapy, and radiation therapy. Methods. Between 1987 an d 1993, 49 patients with malignant pleural mesothelioma underwent extr apleural pneumonectomy. There were two perioperative deaths, and 1 pat ient died 5 weeks after extrapleural pneumonectomy. Thirty-five of the surviving patients received adjuvant chemotherapy (32/35 received cyc lophosphamide, doxorubicin, and cisplatin) followed by hemithorax radi ation therapy. Ten patients received chemotherapy but no radiation the rapy, and 1 patient received no adjuvant therapy. Median follow-up tim e for the 23 living patients from the date of operation was 18 months. Results. Of the 46 evaluable patients, 25 had recurrence (54%), with a median time to first failure of 19 months (range, 5 to 51 months). T he sites of first recurrence were local in 35% of patients, abdominal in 26%, the contralateral thorax in 17%, and other distant sites in 8% , (Some patients had recurrence in multiple sites simultaneously). Con clusions. The most common site of failure after trimodality therapy wa s the ipsilateral hemithorax. Isolated distant failures were uncommon. Future strategies should investigate methods of enhancing local tumor control. (C) 1997 by The Society of Thoracic Surgeons.