ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Can hyperthermic intrathoracic perfusion chemotherapy added to lung sparing surgery be the solution for malignant pleural mesothelioma?
Ahmet Feridun Işık 1, Maruf Şanlı 1, Öner Dikensoy2, İlknur Aytekin 1, Yunus Benli 1, Alper Sevinç3, Celaletdin Camcı3, Bülent Tunçözgür 1, Levent Elbeyli1
1Departments of Thoracic Surgery, Medical School of University of Gaziantep, Gaziantep, Turkey
2Departments of Chest Diseases, Medical School of University of Gaziantep, Gaziantep, Turkey
3Departments of Medical Oncology, Medical School of University of Gaziantep, Gaziantep, Turkey
DOI : 10.5606/tgkdc.dergisi.2016.11798
Background: This study aims to investigate whether hyperthermic intrathoracic perfusion chemotherapy added to lung sparing cytoreductive surgery is superior to extrapleural pneumonectomy in patients with malignant pleural mesothelioma in terms of survival.

Methods: We retrospectively reviewed the data of 73 patients (35 males, 38 females; mean age 55.9±12.3 years; range 20 to 80 years) with malignant pleural mesothelioma hospitalized in our clinic between January 2002 and June 2014. Patients were divided into three groups as group 1 (n=20, extrapleural pneumonectomy alone), group 2 (n=17, palliative treatment alone), and group 3 (n=36, lung sparing cytoreductive surgery plus hyperthermic intrathoracic perfusion chemotherapy). Treatment groups were compared for survival and disease free interval.

Results: Median survivals in group 1, 2 and 3 were five, six, and 27 months, respectively. Two-year survival was 56.5% in group 3 while it was 15% in group 1 and 17.6% in group 2 (p=0.01). However, four-year survival rate was significantly higher in group 3 (14.6%) compared to group 1 (0%) and group 2 (11.8%). The survival time in group 3 was not significantly different between epithelial and biphasic histologies (median 28 and 27 months, respectively).

Conclusion: The results of this study suggest that hyperthermic intrathoracic perfusion chemotherapy added to lung sparing cytoreductive surgery provides longer survival with less morbidity compared to extrapleural pneumonectomy or palliative treatment alone in malignant pleural mesothelioma. We also suggest using hyperthermic intrathoracic perfusion chemotherapy added to lung sparing cytoreductive surgery in cases with non-epithelioid cases of malignant pleural mesothelioma.

Keywords : Hyperthermic perfusion chemotherapy; mesothelioma; pleura; surgery
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