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TRI-MODALITY THERAPY FOR PLEURAL MESOTHELIOMA
(Diffuse Malignant Mesothelioma)

Eric Vallieres MD, Douglas Wood MD, Riyad Karmy-Jones MD, Robert Livingston MD, Karen Hunt MD, Keith Stelzer MD.

Introduction: Extrapleural pneumonectomy (EPP) remains the most effective therapeutic modality to locally control DMM but both systemic and local recurrences are common. The addition of effective chemotherapy and radiation therapy to EPP could potentially improve both local and systemic control and improve survival. This trial evaluates the feasibility of induction cisplatin methotrexate and vinblastine chemotherapy (PMV), EPP and adjuvant neutron radiotherapy (NRT) in the treatment of DMM.

Methods: Patients with clinical stages I-III DMM, Karnofsky 80% or better and who have adequate pulmonary reserves receive induction PMV followed by EPP and adjuvant whole hemithorax NRT. Data is collected prospectively.

Results: Eight patients (7M, 1F), ages 51 to 68, stages I (3), II (2) and III (3) have initiated this protocol. Three patient are completing induction PMV. In the other 5, a clinical response to PMV was seen in 3 patients. Five patients have undergone EPP (4 right, 1 left) and all 5 had positive microscopic margins. There were 3 epithelial DMM and 2 mixed type, pathological stages III (3) and IV (2). There was no operative mortality and hospital stays ranged from 6 to 10 days. Delayed morbidity was major in 3 patients. Four patients have completed adjuvant NRT and 3 remain free of disease at 19, 16 and 5 months.

Conclusion: Induction PMV, EPP and FNRT. appears feasible and safe in this early experience.

Multimodality Approach to Diffuse Malignant Mesothelioma (DMM) of the Pleura A Phase II Prospective Trial UWMC-97

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