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Trimodality therapy for malignant pleural mesothelioma: results from an EORTC phase II multicentre trial

(2010) EUROPEAN RESPIRATORY JOURNAL. 36(6). p.1362-1369
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Abstract
The European Organisation for Research and Treatment of Cancer (EORTC; protocol 08031) phase II trial investigated the feasibility of trimodality therapy consisting of induction chemotherapy followed by extrapleural pneumonectomy and post-operative radiotherapy in patients with malignant pleural mesothelioma (with a severity of cT3N1M0 or less). Induction chemotherapy consisted of three courses of cisplatin 75 mg.m(-2) and pemetrexed 500 mg.m(-2). Nonprogressing patients underwent extrapleural pneumonectomy followed by postoperative radiotherapy (54 Gy, 30 fractions). Our primary end-point was "success of treatment'' and our secondary end-points were toxicity, and overall and progression-free survival. 59 patients were registered, one of whom was ineligible. Subjects' median age was 57 yrs. The subjects' TNM scores were as follows: cT1, T2 and T3, 36, 16 and six patients, respectively; cN0 and N1, 57 and one patient, respectively. 55 (93%) patients received three cycles of chemotherapy with only mild toxicity. 46 (79%) patients received surgery and 42 (74%) had extrapleural pneumonectomy with a 90-day mortality of 6.5%. Post-operative radiotherapy was completed in 37 (65%) patients. Grade 3-4 toxicity persisted after 90 days in three (5.3%) patients. Median overall survival time was 18.4 months (95% CI 15.6-32.9) and median progression-free survival was 13.9 months (95% CI 10.9-17.2). Only 24 (42%) patients met the definition of success (one-sided 90% CI 0.36-1.00). Although feasible, trimodality therapy in patients with mesothelioma was not completed within the strictly defined timelines of this protocol and adjustments are necessary.
Keywords
radiotherapy, prognosis, thoracic surgery, MODULATED RADIATION-THERAPY, DOSE HEMITHORACIC RADIATION, EXTRAPLEURAL PNEUMONECTOMY, SURGICAL-MANAGEMENT, RADICAL SURGERY, CISPLATIN, RESECTION, SURVIVAL, phase II trial, malignant mesothelioma, Chemotherapy

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Chicago
Van Schil, PE, P Baas, R Gaafar, AP Maat, M Van de Pol, B Hasan, HM Klomp, AM Abdelrahman, J Welch, and JP van Meerbeeck. 2010. “Trimodality Therapy for Malignant Pleural Mesothelioma: Results from an EORTC Phase II Multicentre Trial.” European Respiratory Journal 36 (6): 1362–1369.
APA
Van Schil, PE, Baas, P., Gaafar, R., Maat, A., Van de Pol, M., Hasan, B., Klomp, H., et al. (2010). Trimodality therapy for malignant pleural mesothelioma: results from an EORTC phase II multicentre trial. EUROPEAN RESPIRATORY JOURNAL, 36(6), 1362–1369.
Vancouver
1.
Van Schil P, Baas P, Gaafar R, Maat A, Van de Pol M, Hasan B, et al. Trimodality therapy for malignant pleural mesothelioma: results from an EORTC phase II multicentre trial. EUROPEAN RESPIRATORY JOURNAL. 2010;36(6):1362–9.
MLA
Van Schil, PE, P Baas, R Gaafar, et al. “Trimodality Therapy for Malignant Pleural Mesothelioma: Results from an EORTC Phase II Multicentre Trial.” EUROPEAN RESPIRATORY JOURNAL 36.6 (2010): 1362–1369. Print.
@article{1186763,
  abstract     = {The European Organisation for Research and Treatment of Cancer (EORTC; protocol 08031) phase II trial investigated the feasibility of trimodality therapy consisting of induction chemotherapy followed by extrapleural pneumonectomy and post-operative radiotherapy in patients with malignant pleural mesothelioma (with a severity of cT3N1M0 or less).
Induction chemotherapy consisted of three courses of cisplatin 75 mg.m(-2) and pemetrexed 500 mg.m(-2). Nonprogressing patients underwent extrapleural pneumonectomy followed by postoperative radiotherapy (54 Gy, 30 fractions). Our primary end-point was {\textacutedbl}success of treatment'' and our secondary end-points were toxicity, and overall and progression-free survival.
59 patients were registered, one of whom was ineligible. Subjects' median age was 57 yrs. The subjects' TNM scores were as follows: cT1, T2 and T3, 36, 16 and six patients, respectively; cN0 and N1, 57 and one patient, respectively. 55 (93\%) patients received three cycles of chemotherapy with only mild toxicity. 46 (79\%) patients received surgery and 42 (74\%) had extrapleural pneumonectomy with a 90-day mortality of 6.5\%. Post-operative radiotherapy was completed in 37 (65\%) patients. Grade 3-4 toxicity persisted after 90 days in three (5.3\%) patients. Median overall survival time was 18.4 months (95\% CI 15.6-32.9) and median progression-free survival was 13.9 months (95\% CI 10.9-17.2). Only 24 (42\%) patients met the definition of success (one-sided 90\% CI 0.36-1.00).
Although feasible, trimodality therapy in patients with mesothelioma was not completed within the strictly defined timelines of this protocol and adjustments are necessary.},
  author       = {Van Schil, PE and Baas, P and Gaafar, R and Maat, AP and Van de Pol, M and Hasan, B and Klomp, HM and Abdelrahman, AM and Welch, J and van Meerbeeck, JP},
  issn         = {0903-1936},
  journal      = {EUROPEAN RESPIRATORY JOURNAL},
  keyword      = {radiotherapy,prognosis,thoracic surgery,MODULATED RADIATION-THERAPY,DOSE HEMITHORACIC RADIATION,EXTRAPLEURAL PNEUMONECTOMY,SURGICAL-MANAGEMENT,RADICAL SURGERY,CISPLATIN,RESECTION,SURVIVAL,phase II trial,malignant mesothelioma,Chemotherapy},
  language     = {eng},
  number       = {6},
  pages        = {1362--1369},
  title        = {Trimodality therapy for malignant pleural mesothelioma: results from an EORTC phase II multicentre trial},
  url          = {http://dx.doi.org/10.1183/09031936.00039510},
  volume       = {36},
  year         = {2010},
}

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