P31. Outcome after trimodality therapy with intracavitary hydrogen peroxide therapy in malignant pleural mesothelioma
CELCC 2014 Abstracts

P31. Outcome after trimodality therapy with intracavitary hydrogen peroxide therapy in malignant pleural mesothelioma

Paul Stockhammer1, Yawen Dong1, Thomas Klikovits1, Clemens Aigner1, Shahrokh Taghavi1, Gyoergy Lang1, Sabine Zöchbauer2, Karin Dieckmann3, Walter Klepetko1, Mir Alireza Hoda1

1Division of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; 2Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; 3Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria


Background: Malignant pleural mesothelioma (MPM) is an aggressive malignancy related to asbestos exposure. Trimodality therapy (TMT) involving extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D) with neoadjuvant or adjuvant chemotherapy and adjuvant radiotherapy is a widely accepted treatment protocol with curative intent. Recently a combination of TMT with intracavitary treatment strategies has been reported to be beneficial. In this study we investigated the impact of TMT in combination with intraoperative hydrogen peroxide treatment in patients with MPM.

Methods: All MPM patients who were referred for surgical therapy within a TMT protocol between 2000 and 2012 were enrolled in this study. Data was collected retrospectively until 2005 and prospectively from 2006 from patients who underwent at least three cycles of induction chemotherapy followed by EPP and intraoperative hydrogen peroxide treatment and postoperative intensity modulated radiotherapy up to 58 Grays.

Results: A total of 30 patients completed TMT and intraoperative hydrogen peroxide treatment during the observation period. There were 24 males and six female with a mean age of 61 years at the time of diagnosis. Median follow-up was 18.5 months. Histological subtypes were epitheliod MPM in 23, biphasic MPM in six and sarcomatiod MPM in one patient. Eighteen patients were in late stage whereas 12 patients were in early stage at the time of diagnosis. Four (13.3%) patients experienced major postoperative complications. These complications requiring re-thoracotomy were: bleeding, patch rupture, bronchopleural fistula. Overall median survival (Kaplan-Meier) was 31 months (95% CI: 12-48 months). The 1-year survival was 80%, 2-year survival was 55% and 3-year survival was 45%. The 30 day mortality was nil.

Conclusions: In our experience, EPP in combination with intraoperative hydrogen peroxide treatment within a TMT protocol is a well-tolerated and feasible treatment approach. Compared to reported classical TMT protocols trials, morbidity and perioperative mortality rates are lower and median survival is equal or better.

Keywords: Pleural mesothelioma; therapy


doi: 10.3978/j.issn.2218-6751.2014.AB043


Cite this article as: Stockhammer P, Dong Y, Klikovits T, Aigner C, Taghavi S, Lang G, Zöchbauer S, Dieckmann K, Klepetko W, Hoda MA. Outcome after trimodality therapy with intracavitary hydrogen peroxide therapy in malignant pleural mesothelioma. Transl Lung Cancer Res 2014;3(5):AB043. doi: 10.3978/j.issn.2218-6751.2014.AB043

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