Effect of induction chemotherapy on lung function and exercise capacity in patients affected by malignant pleural mesothelioma

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• 作者：Giuseppe Marulli ; Federico Rea ; Samuele Nicotra ; Adolfo Gino Favaretto ; Egle Perissinotto ; Maddalena Chizzolini ; Andrea Vianello ; Fausto Braccioni
• 关键词：Malignant pleural mesothelioma ; Induction chemotherapy ; Spirometry ; Cardiopulmonary exercise test
• 刊名：European Journal of Cardio-Thoracic Surgery
• 出版年：2010
• 出版时间：June 2010
• 年：2010
• 卷：37
• 期：6
• 页码：1464-1469
• 全文大小：198 K

文摘

Objectives: The effect of induction chemotherapy (IC) on lung function and exercise capacity in patients with malignant pleural mesothelioma (MPM) has not been largely examined. The aim of this study was to evaluate the changes in pulmonary function and oxygen consumption following IC in patients with MPM. Methods: Between 2004 and 2009, 36 consecutive patients (mean age 62.1 ± 1.5 years, M/F = 25/11) were prospectively investigated. Data concerning medical history, histology, staging and response to chemotherapy were collected. All patients underwent pulmonary function test before (in the absence of pleural effusion) and after chemotherapy (platinum-based agent plus pemetrexed); 23 out of 36 patients also performed a cardiopulmonary incremental exercise test. Results: An epithelioid histotype was documented in 88.8 % of patients. A partial response to chemotherapy was observed in 44.5 % of cases and 36.1 % of patients experienced grade 2–3 toxicity. A significant improvement in forced expiratory volume in 1 s (FEV₁) (0.13 ± 0.30 l; P = 0.01), in VO₂ peak (1.76 ± 2.91 ml kg⁻¹ min⁻¹; P = 0.005), in PaO₂ at rest (4.76 ± 9.84 mmHg; P = 0.03) and in PaO₂ at peak exercise (6.26 ± 12.72 mmHg; P = 0.04) was detected. The diffusion capacity of the lung for carbon monoxide (DLCO) also increased (1.25 ± 4.68 ml min⁻¹ mmHg⁻¹), although not significantly (P = 0.20). The stratified analysis based on the response to IC showed a significant improvement in FEV₁, forced vital capacity (FVC) and vital capacity (VC) (both absolute and percentage of predicted values) only in patients with a partial response. Conclusions: An improvement in lung function and exercise capacity was seen after IC in patients with MPM. These data suggest that IC does not compromise cardiopulmonary performance in this subset of patients.