| Autor: |
Bongiolatti S; Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy., Mazzoni F; Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy., Salimbene O; Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy., Caliman E; Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy., Ammatuna C; Department of Experimental and Clinical Medicine, Section of Surgery, Histopathology and Molecular Pathology, University of Florence, 50134 Florence, Italy., Comin CE; Department of Experimental and Clinical Medicine, Section of Surgery, Histopathology and Molecular Pathology, University of Florence, 50134 Florence, Italy., Antonuzzo L; Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy., Voltolini L; Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy.; Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy. |
| Abstrakt: |
Malignant pleural mesothelioma (MPM) is an aggressive disease with poor prognosis and the current treatment for early-stage MPM is based on a multimodality therapy regimen involving platinum-based chemotherapy preceding or following surgery. To enhance the cytoreductive role of surgery, some peri- or intra-operative intracavitary treatments have been developed, such as hyperthermic chemotherapy, but long-term results are weak. The aim of this study was to report the post-operative results and mid-term outcomes of our multimodal intention-to-treat pathway, including induction chemotherapy, followed by surgery and Hyperthermic Intraoperative THOracic Chemotherapy (HITHOC) in the treatment of early-stage epithelioid MPM. Since 2017, stage I or II epithelioid MPM patients have been inserted in a surgery-based multimodal approach comprising platinum-based induction chemotherapy, followed by pleurectomy and decortication (P/D) and HITHOC with cisplatin. The Kaplan-Meier method was used to estimate overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS). During the study period, n = 65 patients affected by MPM were evaluated by our institutional Multidisciplinary Tumour Board; n = 12 patients with stage I-II who had no progression after induction chemotherapy underwent P/D and HITHOC. Post-operative mortality was 0, and complications developed in n = 7 (58.3%) patients. The median estimated OS was 31 months with a 1-year and 3-year OS of 100% and 55%, respectively. The median PFS was 26 months with 92% of a 1-year PFS, whereas DFS was 19 months with a 1-year DFS rate of 83%. The multimodal treatment of early-stage epithelioid MPM, including induction chemotherapy followed by P/D and HITHOC, was well tolerated and feasible with promising mid-term oncological results. |
