Impact of induction therapy on postoperative outcome after extrapleural pneumonectomy for malignant pleural mesothelioma: does induction-accelerated hemithoracic radiation increase the surgical risk?

摘要: OBJECTIVES Patients with malignant pleural mesothelioma (MPM) eligible for extrapleural pneumonectomy (EPP) may benefit from induction chemotherapy (CT) as historically described, or induction-accelerated hemithoracic intensity-modulated radiation therapy (IMRT) a potential alternative. However, the impact of type on postoperative morbidity and mortality remains unknown. METHODS We performed retrospective study including every patient who underwent EPP MPM in our institution between January 2001 December 2014. without treatment (n = 7) undergoing both CT IMRT 2) were then excluded. The remaining patients (study group) divided according to Group 1-CT 2-IMRT. Major complications defined by Grade 3 higher National Cancer Institute Common Terminology Criteria Adverse Events 4.0 guidelines. Red blood cell (RBC) transfusion was analysed number packs, dichotomized <3 vs ≥3 packs. Plasma platelet units, no versus any plasma transfusion. RESULTS Altogether, 126 (mean age 61.3 ± 8.1 years, males 82.5%, right side 60.3%, 90-day rate 4.8%) accounted group. Sixty-four included 62 When compared 1-CT, 2-IMRT characterized older (59.3 9.2 63.3 8.3 P 0.012), more right-sided resections (46.8 74.1%, 0.003), advanced disease (pathological stage IV: 28.1 53.2%, 0.007), less RBC transfusions (5.1 3.0 2.4 < 0.001), (31.2 9.6%, 0.005) similar major (29.6 35.4%, 0.614). 6.2% 4) 3.2% 2-RT 2, 0.680). Induction significantly associated decreased risk RBCs [odds ratio (OR) 0.10, 95% confidence interval (CI) 0.04-0.23, 0.001] well platelets (OR 0.25, CI 0.086-0.67, 0.008). CONCLUSIONS In this large single-centre series MPM, implementation not significant increase surgical risks above beyond CT. switch resection tumours, requirements, comparable mortality.