Survival after trimodality therapy for XXXX : Radical Pleurectomy, chemotherapy with @entity900 /Pemetrexed and radiotherapy.

@entity1 @entity3620 @entity900 @entity5
INTRODUCTION: The role of surgery in the management of @entity3620 ( @entity3620 ) is controversial and there are no established guidelines. We describe the feasibility and long-term outcomes associated with Radical Pleurectomy (RP) as surgical therapy modality in a standardized trimodality therapy concept of @entity3620 . METHODS: From November 2002 to October 2007, 35 out of 102 consecutive @entity1 with @entity3620 were enrolled in our prospective database. They underwent trimodality therapy, including RP followed by 4 cycles of chemotherapy with @entity900 (75 mg/m(2))/Pemetrexed (500 mg/m(2)) and radiotherapy 4-6 weeks after operation. RESULTS: Median age was 65 years. Nineteen @entity1 were in advanced stages III and IV (54.3%). @entity5 histology was epithelial in 27 @entity1 (77.1%). Macroscopic complete resection could be achieved in 18 @entity1 (51.4%). Surgical morbidity/mortality and trimodality treatment-related mortality were 20.0%, 2.9% and 5.8%, respectively. Thirty-three @entity1 completed the trimodality therapy. Median follow-up was 21.7 months. Overall median survival was 30.0 months. One-, 2-, and 3-year-survival were 69%, 50% and 31%, respectively. Advanced stages III/IV (p=0.06), macroscopic incomplete resections (p=0.001), non-epithelial histology (p=0.55) and nodal metastases (p=0.19) were associated with poorer survival. CONCLUSIONS: The trimodality therapy concept with RP demonstrates promising results in terms of long-term survival, morbidity and mortality. We propose that a surgical philosophy of limiting the procedure related morbidity while achieving comparable cytoreductive results allows @entity1 to maintain physiological reserve to be eligible for multimodality treatment options in the long-term. The observed and theoretical benefits of this trimodality treatment approach warrant confirmation in larger RCT.
