亚洲免费av电影一区二区三区,日韩爱爱视频,51精品视频一区二区三区,91视频爱爱,日韩欧美在线播放视频,中文字幕少妇AV,亚洲电影中文字幕,久久久久亚洲av成人网址,久久综合视频网站,国产在线不卡免费播放

        ?

        Extra-pleural pneumonectomy in the setting of tri-modality therapy for patients with malignant pleural mesothelioma

        2013-06-12 12:33:49AlexanderChiSijinWenNamNguyenGeraldineJacobsonScotRemickWilliamTseZhongxingLiao
        Chinese Journal of Cancer Research 2013年2期

        Alexander Chi, Sijin Wen, Nam P. Nguyen, Geraldine Jacobson, Scot Remick, William Tse, Zhongxing Liao

        1Department of Radiation Oncology, West Virginia University, Morgantown, WV 26506, USA;2Department of Biostatistics, West Virginia University, Morgantown, WV 26506, USA;3Department of Radiation Oncology, University of Arizona, Tucson, AZ 85724, USA;4Mary Babb Randolph Cancer Center, Morgantown, WV 26506, USA;5Department of Hematology Oncology, West Virginia University, Morgantown, WV 26506, USA;6Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA

        Extra-pleural pneumonectomy in the setting of tri-modality therapy for patients with malignant pleural mesothelioma

        Alexander Chi1, Sijin Wen2, Nam P. Nguyen3, Geraldine Jacobson1, Scot Remick4, William Tse5, Zhongxing Liao6

        1Department of Radiation Oncology, West Virginia University, Morgantown, WV 26506, USA;2Department of Biostatistics, West Virginia University, Morgantown, WV 26506, USA;3Department of Radiation Oncology, University of Arizona, Tucson, AZ 85724, USA;4Mary Babb Randolph Cancer Center, Morgantown, WV 26506, USA;5Department of Hematology Oncology, West Virginia University, Morgantown, WV 26506, USA;6Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA

        Corresponding to:Alexander Chi, M.D. Department of Radiation Oncology, West Virginia University 1 Medical Center Dr. Morgantown, WV 26505, USA. Email: achiaz2010@gmail.com.

        Submitted Jan 16, 2013. Accepted for publication Feb 19, 2013.

        Scan to your mobile device or view this article at:http://www.thecjcr.org/article/view/1507/2470

        Although declining in the US due to restrictions of asbestos exposure, malignant pleural mesothelioma (MPP) remains a very serious thoracic malignancy that is rising in incidence worldwide (1). Trimodality therapy with chemotherapy and radiotherapy combined with extrapleural pneumonectomy (EPP) has gained acceptance given the acceptable mortality rate (<5%) and long term survival reported in patients with epithelial histology, negative margins, and no extrapleural lymph node involvement after trimodality treatment (2). Since then, multiple studies have been published reported excellent median survival of >20 months after trimodality therapy (1). However, this treatment approach continues to be controversial given recent publications demonstrating that EPP may lead to poorer survival and increased mortality from surgery when compared with pleurectomy/ decortication (P/D) (3-5). As shown in a large retrospective review of patients who have undergone EPP or P/D, the operative mortality was found to be 7% after EPP and 4% after P/D with a hazard rate of 1.4 for EPP found after multivariate analysis (P<0.001) (3). In a non-randomized prospective study comparing EPP and P/D in the setting of trimodality therapy, prolonged median survival was observed after P/D, hyperthermic pleural lavage with povidone-iodine, and adjuvant chemotherapy and prophylactic radiotherapy when compared with neoadjuvant chemotherapy, EPP, and adjuvant radiotherapy (23vs. 12.8 months, P=0.004). Although improved survival is suggested, no conclusion regarding to whether EPP will lead to inferior survival when compared with P/D can be made due to the nature of these studies. In 2011, a prospective study (MARS) that attempts to compare EPP and P/D in a randomized fashion was reported (5). The aim of this study was to investigate the effect of EPP in the context of trimodality therapyvs. no EPP on the survival and quality of life in patients with malignant pleural mesothelioma. Due to the rarity of this disease, the feasibility of randomizing 50 patients in 1 year after neoadjuvant chemotherapy was explored. Among 112 patients registered between 2005 and 2008, 50 patients (T1-T3, N0-N1, and M0) were randomized to EPPvs. no EPP (24vs. 26). Among the 24 patients randomized to EPP, the procedure was only completed in 16 patients (3 total operative mortalities) and 8 of these 16 patients received radical radiotherapy afterwards. While no significant differences between groups were reported in the quality of life analyses, the hazard ratio for overall survival between the EPP and no EPP groups were 2.75 (P=0.016) after adjusting for sex, histological subtype, stage, and age at randomization. Although the data analysis was appropriate, the sample size is too small to make any conclusion regarding to patient survival after EPPvs. no EPP (power calculation was based on 670 patients). Also, the final conclusion of EPP shortens survival is not supported by statistical inference, but just based on the descriptive statistics. For example, a formal boundary (a cutoff of a statistic) in the interim analysis should be used to make a statistical inference or conclusion. Therefore, theconclusion of this study really needs to be interpreted with caution.

        More recently, a systematic review of trimodality therapy for malignant pleural mesothelioma has been conducted (6). Among the 16 studies included, the median survival ranged from 12.8 to 46.9 months and the perioperative mortality varied from 0 to 12.5% but mostly <5%. Large variation in median survival has been observed, but 6 studies reported median survival of ≥20 months. Given the current level of evidence, further studies need to be conducted to further investigate the effect of EPP on the survival of patients with malignant pleural mesothelioma, especially when advanced technology is applied in the delivery of adjuvant RT, which may potentially improve the survival of patients with malignant pleural mesothelioma in the setting of both EPP and P/D (7,8).

        Acknowledgements

        Disclosure:The authors declare no conflict of interest.

        1. Chi A, Liao Z, Nguyen NP, et al. Intensity-modulated radiotherapy after extrapleural pneumonectomy in the combined-modality treatment of malignant pleural mesothelioma. J Thorac Oncol 2011;6:1132-41.

        2. Sugarbaker DJ, Flores RM, Jaklitsch MT, et al. Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg 1999;117:54-63; discussion 63-5.

        3. Flores RM, Pass HI, Seshan VE, et al. Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients. J Thorac Cardiovasc Surg 2008;135:620-6, 626.e1-3.

        4. Lang-Lazdunski L, Bille A, Lal R, et al. Pleurectomy/ decortication in superior to extrapleural pneumonectomy in the multimodality management of patients with malignant pleural mesothelioma. J Thorac Oncol 2012;7:737-43.

        5. Treasure T, Lang-Lazdunski L, Waller D, et al. Extrapleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study. Lancet Oncol 2011;12:763-72.

        6. Cao C, Tian D, Manganas C, et al. Systematic review of trimodality therapy for patients with malignant pleural mesothelioma. Ann Cardiothorac Surg 2012;1:428-37.

        7. Tonoli S, Vitali P, Scotti V, et al. Adjuvant radiotherapy after extrapleural pneumonectomy for mesothelioma. Prospective analysis of a multi-institutional series. Radiother Oncol 2011;101:311-5.

        8. Minatel E, Trovo M, Polesel J, et al. Tomotherapy after pleurectomy/decortication or biopsy for malignant pleural mesothelioma allows the delivery of high dose of radiation in patients with intact lung. J Thorac Oncol 2012;7:1862-6.

        Cite this article as:Chi A, Wen S, Nguyen NP, Jacobson G, Remick S, Tse W, Liao Z. Extra-pleural pneumonectomy in the setting of tri-modality therapy for patients with malignant pleural mesothelioma. Chin J Cancer Res 2013;25(2):128-129. doi: 10.3978/j.issn.1000-9604.2013.02.05

        10.3978/j.issn.1000-9604.2013.02.05

        亚洲精品国产一二三无码AV| 内射人妻无套中出无码| 中国丰满人妻videoshd| 亚洲综合无码一区二区三区| 国产高清在线91福利| 日本免费播放一区二区| 人妻丝袜中文无码av影音先锋专区 | 日韩人妻美乳中文字幕在线| 亚洲一区精品无码| 亚洲av无码专区电影在线观看 | 青青草成人免费在线观看视频| 精品久久久久久久无码人妻热| 精品熟女少妇av免费观看| 久草视频在线这里只有精品| 婷婷久久av综合一区二区三区| 国产在线精品一区二区中文| 国产成人免费a在线视频| 日韩极品视频在线观看| 亚洲国产中文字幕在线视频综合| 欧美中日韩免费观看网站| 亚洲综合免费| 日本高清一区二区三区不卡| 久久精品99国产精品日本| 亚洲精品无码久久久久av麻豆| 午夜不卡亚洲视频| 亚洲成人精品在线一区二区| 亚洲性无码一区二区三区| 亚洲日韩欧美一区二区三区| 国产免费人成网站在线播放| 91久久精品色伊人6882| 亚洲av无码精品色午夜| 国产欧美日韩专区毛茸茸| 麻豆精品在线视频观看| 亚洲va国产va天堂va久久| 亚洲区小说区图片区qvod伊| 白白色青青草视频免费观看| 欧美性受xxxx黑人猛交| 一本大道东京热无码| 日韩精品中文字幕综合| 熟妇人妻无乱码中文字幕av| 国产真实伦在线观看|