Harvard Mesothelioma Trimodality

Background

Retrospective analysis. N=183 MPM patients treated at Brigham and Women's Hospital 1980–1997. All underwent EPP → adjuvant chemotherapy → radiotherapy (trimodality). Among the largest EPP series at publication; aim to identify prognostic variables for long-term survival.

Interventions and follow up

Treatment: Extrapleural pneumonectomy + adjuvant chemotherapy (carboplatin/paclitaxel) + adjuvant hemithoracic RT 54 Gy
Primary endpoint: Overall survival and pattern of failure
mFollow up: Median 13 months

Results

Perioperative mortality: 3.8% (7/183)
2-yr OS: 38%
5-yr OS: 15% (median 19 months)
Favorable prognostic factors (univariate and multivariate): Epithelial histology (5-yr OS 21%), negative resection margins (5-yr OS 25%), N0 extrapleural nodes (5-yr OS 17%)
All 3 favorable factors (N=31): 5-yr OS 46%, median 51 months

Adverse events

Perioperative morbidity: 50%
Perioperative mortality: 3.8% (improved from earlier series)
Adjuvant RT/chemotherapy: Well tolerated in most; long-term survivors had low rates of late toxicity

Conclusions

Trimodality therapy for MPM was feasible with 3.8% perioperative mortality and 5-yr OS 15% overall. Patients with all 3 favorable factors had 46% 5-yr OS, establishing a prognostic scoring system for patient selection.

Key Limitations

Retrospective, single-institution over 17 years; heterogeneous treatment eras; no comparator; favorable subset small (N=31); prognostic factors hypothesis-generating.

Clinical Context

Foundational EPP trimodality series; the 3-factor prognostic model guided selection for decades. Subsequent randomized data (MARS) questioned routine EPP; lung-sparing approaches now favored.

References