O-104DOES THE TIMING OF CHEMOTHERAPY AFFECT OUTCOME FOLLOWING RADICAL SURGERY FOR MALIGNANT PLEURAL MESOTHELIOMA?

• Published in: Interactive cardiovascular and thoracic surgery 2014-06, Vol.18 (suppl_1), p.S27-S27
• Main Authors: Jane Sharkey, Annabel, Fennell, D., Nakas, A., O'Byrne, K.J., Waller, D.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivu167.104

Objectives: There is little evidence regarding the use of chemotherapy as part of treatment of malignant pleural mesothelioma (MPM). Apparent survival benefit with adjuvant chemotherapy may be due to selection bias. We aimed to determine whether, in patients fit for chemotherapy, a delay in treatment affected survival. Methods: We analysed postoperative variables of 250 patients undergoing either extrapleural pneumonectomy (EPP) or extended pleurectomy-decortication (EPD) for MPM from a prospective database at a single centre. There was no standard protocol for additional chemotherapy: the rationale for giving or withholding chemotherapy in the neo-adjuvant and adjuvant settings was dependent on individual oncological preference and varied with referral centre. Results: Of the 249 patients, 57 were excluded from further analysis: 33 died before oncological assessment, 23 progressed before adjuvant therapy was discussed or commenced, and one patient only had radiotherapy. Of the remaining 192 patients: 166 (86.5%) were male, median age 59 years (range 14-78). One hundred and nineteen patients (62.5%) had EPD. The majority of patients had epithelioid histology (77.2%) and IMIG stage III disease (56.5%). One hundred patients (51.8%) had pathological nodal disease (N1 or N2). Outcome was compared between 4 groups: neo-adjuvant therapy, true adjuvant therapy, delayed chemotherapy reserved for recurrence in those otherwise fit, and those unfit for chemotherapy. Overall there was no effect of the timing of chemotherapy on survival, but in lymph node positive patients, progression free survival was significantly increased if chemotherapy was not delayed until progression (4.8 vs 10.3 months, HR 2.877, 95% CI 1.240–6.677, P = 0.01). Similarly in those with biphasic MPM, delaying chemotherapy until progression significantly reduced overall survival (4.9 vs 15.9 months, HR 3.878, 95% CI 1.430-10.516, P = 0.004). Conclusions: Our results suggest that the timing of additional chemotherapy may be important in those with a poorer prognosis on the basis of cell type and nodal stage. In these patients additional postoperative chemotherapy should not be delayed. Disclosure: No significant relationships.