ADJUVANT RADIOTHERAPY AND EXTRAPLEURAL PNEUMONECTOMY TO TREAT PLEURAL MESOTHELIOMA
Study by Brega Massone, C. Lequaglie, B. Conti, * B. Magnani, I. Cataldo of Oncology Thoracic Surgery, from the National Tumor Institute of Milan, and Statistics Unit of IIAARR in the Univesity of Pavia in Italy.
Malignant pleural mesothelioma is still considered a rare disease of the pleura. Currently it is informed of any standard treatment of this tumor. The increasing incidence of short average age of the patients disease associated with one of the first surgeons induced in the absence of alternative therapy to execute extrapleural pneumonectomy, considered, in the past, a great risk intervention not always balanced diagnostic impact favorable prognosis. The aim of the study is evaluate the effectiveness, or not, of this surgery and its impact on long-term survival.
In the Surgery Department of the National Cancer Institute Department of Thoracic Milan, from 1994 to 1997, 17 patients underwent extrapleural pneumonectomy with malignant pleural mesothelioma. Nine were men and 8 women. The average age was 51.82 ± 10.23 years, with a median of 54 years (range 31-65 years). Selective parameters for admission to this treatment were good condition of the patient, clinical stage I, Postpneumonectomy predictive FEV 1> 1300 ml. and decreased perfusion resectable> = 50% lung. The surgical technique used in our experience, was described by Sugarbaker.
7 right and 10 left extrapleural pneumonectomy was performed. Perioperative mortality was zero. Reconstruction pericardium was performed in 13 cases with a Gore-Tex patch and 4 Marlex patch. Iris was rebuilt in 9 patients by reverse latissimus dorsi flap in 4 Teflon, in Mother 2 2 dura and Goretex. Histological test showed epithelioid mesothelioma 13, 2 and 2 biphasic sarcomatous. Eight subjects had stage III and 9 in stage I. All patients received adjuvant radiotherapy. The average disease-free interval was 16.54 ± 12.31 months, with a median of 12 months (range, 5-50 months) :. Median survival was 26.50 ± 15.60 months, with a median of 22.5 months, ranging from 9-59 months.
Extrapleural pneumonectomy in conjunction with adjuvant radiotherapy seems to be an appropriate treatment for some selected patients with a malignant pleural mesothelioma. By our database we revealed that extrapleural pneumonectomy also has a low risk of disease with a good quality of life. Postoperative respiratory function was, on average, 70% of starting value.