{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T14:14:01Z","timestamp":1775744041108,"version":"3.50.1"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2018,11,26]],"date-time":"2018-11-26T00:00:00Z","timestamp":1543190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Multimodality therapy with preoperative radiation (RT) followed by extrapleural pneumonectomy (EP) for patients with operable malignant pleural mesothelioma (MPM) has demonstrated encouraging results. At relapse, there are few data on the tolerance and efficacy of systemic therapies after prior multimodality therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective analysis of patients with relapsed MPM after RT and EPP \u00b1 adjuvant chemotherapy to determine overall survival (OS; date of relapse to death) and the proportion of patients that received systemic therapy and associated response rate (RR). OS was estimated using Kaplan\u2013Meier method and potential prognostic variables were examined.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Fifty-three patients were included (2008\u20132016). Median OS was 4.8 months (median follow-up 4.4 months, range 0.03\u201334.8). Eastern Cooperative Oncology Group (ECOG) performance status (PS) \u22652, disease-free interval (DFI) &amp;lt;1 year, and hemoglobin \u2264110 g\/L at recurrence were associated with worse prognosis. Thirty-six percent of patients received any systemic therapy, whereas it was omitted in 62% because of poor PS. RR was 15% (0 complete responses, 15% partial responses) in 13 individuals with response-evaluable disease. Therapy was discontinued because of toxicity (6\/15) or disease progression (5\/15), and median number of cycles was four.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Patients with relapsed MPM following RT and EPP, especially those with ECOG PS \u22652, DFI &amp;lt;1 year, and hemoglobin \u2264110 g\/L at recurrence, have poor prognosis and low RR to first-line systemic therapy. Earlier detection and novel diagnostic markers of relapse as well as potential neoadjuvant or adjuvant systemic therapy should be investigated in future studies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1634\/theoncologist.2018-0501","type":"journal-article","created":{"date-parts":[[2018,11,26]],"date-time":"2018-11-26T20:54:19Z","timestamp":1543265659000},"page":"e510-e517","source":"Crossref","is-referenced-by-count":11,"title":["Systemic Therapy Use and Outcomes After Relapse from Preoperative Radiation and Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma"],"prefix":"10.1093","volume":"24","author":[{"given":"Sara V.","family":"Soldera","sequence":"first","affiliation":[{"name":"Department of Hematology and Oncology, CISSS Mont\u00e9r\u00e9gie Centre\/H\u00f4pital Charles-Lemoyne, Universit\u00e9 Sherbrooke, Quebec, Canada"},{"name":"Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Kavanagh","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Health Network, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melania","family":"Pintilie","sequence":"additional","affiliation":[{"name":"Biostatistics Division, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasha B.","family":"Leighl","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Perrot","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Hope","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald","family":"Feld","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Penelope A.","family":"Bradbury","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret 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