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Eur J Cardiothorac Surg 2007;31:529-534. doi:10.1016/j.ejcts.2006.11.046
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

A phase II study of intrapleural immuno-chemotherapy, pleurectomy/decortication, radiotherapy, systemic chemotherapy and long-term sub-cutaneous IL-2 in stage II–III malignant pleural mesothelioma

^a Division of Thoracic Surgery, Cardiac and Thoracic Department, University of Pisa, Pisa, Italy
^b Division of Pneumology, Cardiac and Thoracic Department, University of Pisa, Pisa, Italy
^c Division of Pathology, University of Pisa, Pisa, Italy

Received 23 August 2006; received in revised form 24 November 2006; accepted 28 November 2006.

^_* Corresponding author. Address: Division of Thoracic Surgery, Cardiac and Thoracic Department, University of Pisa, Via Paradisa 2, Pisa 56124, Italy. Tel.: +39 050 995226; fax: +39 050 577239. (Email: m.lucchi{at}med.unipi.it).

Objective: From therapeutic nihilism to extremely aggressive management, there is a wide range of possibilities in the treatment of malignant pleural mesothelioma (MPM). Unfortunately, there is little evidence as regards the best treatment to offer to the MPM patients. In 1999, we started a phase II study based on the multimodality treatment of stage II–III MPM, the results of which have been analysed and reported. Methods: From 1999 to 2004, 49 patients with IMIG stage II–III MPM underwent a multimodality treatment including: intrapleural pre-operative interleukin 2 (IL-2, 18 x 10⁶ UI/day per 3 days), pleurectomy/decortication, intrapleural post-operative epidoxorubicin (25 mg/m² per 3 days), IL-2 (18 x 10⁶ UI/day per 3 days), adjuvant radiotherapy (30 Gy), systemic chemotherapy (cisplatin 80 mg/m² day 1, gemcitabine 1250 mg/m² day 1 and 8 up to 6 courses) and long-term sub-cutaneous IL-2 (3 x 10⁶ UI/day 3 days per week). Results: There were 41 males and 8 females with a median age of 61 years (range 41–77). All the patients had a diagnosis of MPM by thoracoscopy before inclusion. We did not experience any post-operative mortality. The histology was: 39 epitheliomorf, 6 bifasic and 4 sarcomatous. According to the IMIG the post-operative staging was III in 40 cases and II in 9 cases. With a median follow-up of 59 months (range 14–81) 13 patients are still alive and the median actuarial survival is 26 months (31 and 21 months for stage II and III, respectively). Only the Performance Status at the diagnosis affected survival significantly. Conclusions: The multimodality treatment we adopted for stage II–III MPM was feasible, well tolerated by most of the patients and produced a favourable outcome. New targeted therapies are awaited for further improvements in the treatment of this disease.

Key Words: Mesothelioma • Multimodality treatments • Pleurectomy • Chemotherapy • Immunotherapy

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