Optimal management of XXXX after subtotal pleurectomy: revisiting the role of intrapleural chemotherapy and postoperative radiation.

@entity1 @entity137 @entity1138 @entity900 @entity2615 @entity3620 @entity3483
@entity3620 ( @entity3620 ) is a generally fatal disease with no standard treatment. There are encouraging reports using intraperitoneal chemotherapy to treat peritoneal @entity2615 and intrapleural chemotherapy (IPC) to treat @entity3483 . Our objective was to evaluate the efficacy of IPC after subtotal pleurectomy. Between 1988 and 1992, 20 consecutive @entity1 with diffuse @entity3620 limited to one hemithorax underwent subtotal pleurectomy. Thirteen @entity1 with biopsy-proven @entity3620 known prior to thoracotomy were enrolled in a phase II combined modality protocol consisting of perioperative intrapleural @entity900 (100 mg/m2) and ara-C (1,200 mg) after subtotal pleurectomy, followed by systemic @entity900 (50 mg/m2/week x 8) and @entity1138 (8 mg/m2, days 1 and 36). Seven @entity1 with @entity3620 could not be enrolled because their diagnosis was made post-thoracotomy. These @entity1 underwent subtotal pleurectomy with (n = 4) or without (n = 3) adjuvant radiation (4,500-5,000 cGy in 3 @entity1 , 2,100 cGy in 1 @entity1 ). One of three @entity1 who developed chemotherapy-related nephrotoxicity died, the only treatment-related mortality. All 3 @entity1 requiring postoperative readmission received IPC. Significant morbidity did not occur in @entity1 not receiving chemotherapy. Median survival and time to progression were significantly longer in @entity1 not receiving IPC (21 vs. 9 months, P = 0.04; 12 vs. 6 months, P = 0.01). In conclusion, intrapleural and postoperative systemic chemotherapy resulted in significant @entity137 and did not improve survival in our @entity1 who underwent subtotal pleurectomy for @entity3620 .
