***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: BACKGROUND Malignant pleural mesothelioma is a mainly asbestos-related neoplasm that occurs with increasing frequency and is associated with a poor prognosis . Extrapleural pneumonectomy which was initially performed as a st and -alone treatment in patients with resectable disease is now currently almost uniformly applied as part of a multi-modal approach . Its value and advantage over other therapeutic strategies remain points of discussion . We therefore analysed our experience with extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma . METHODS We retrospectively review ed our institutional experience with all consecutive patients undergoing extrapleural pneumonectomy for malignant pleural mesothelioma from 1994 to 2005 . Patients were analysed with regard to hospital mortality and morbidity and long-term outcome . RESULTS Forty-nine patients ( 10 female/39 male , mean age 58 + 12 years ) underwent extrapleural pneumonectomy during the observation period . Median ICU stay was 1 day , median postoperative length of hospital stay was 13 days . After a mean follow-up of 2573 days , median survival was 376 days ( mean 672 + 121 days , range 9 - 3384 ) . One-year survival was 53 % , 3-year survival 27 % and 5-year survival 19 % . CONCLUSION Extrapleural pneumonectomy as part of a multi-modality treatment regimen is a good treatment option for selected patients with malignant pleural mesothelioma . The long-term results of this limited series compare favourably to non-surgical treatment regimens . Larger r and omised prospect i ve multi-centre trials are warranted to establish clear guidelines BACKGROUND Trimodality therapy seems to be the best treatment for malignant pleural mesothelioma ( MPM ) . A large experience served to evaluate the efficacy of surgery followed by adjuvant chemo-radiotherapy . Trimodality therapy results have led us to test induction chemotherapy followed by EPP and adjuvant radiotherapy in stages I-III of MPM . The aim of our study was to evaluate the feasibility of this protocol and to estimate survival . METHODS From 2000 to 2003 , 21 patients with MPM ( 14 males and 7 females , median age 59 years ) were enrolled in the prospect i ve study .  Induction chemotherapy consisted of Carboplatin ( AUC 5mg/mL/min on Day 1 ) and Gemcitabine ( 1000mg/m(2 ) on Days 1 , 8 , 15 ) for three to four cycles . EPP was performed 3 - 5 weeks after induction therapy , while post-operative RT was given 4 - 6 weeks after operation . RESULTS Ten patients received three cycles of chemotherapy , 10 patients received four cycles and 1 patient had two cycles . Grade s 3 - 4 haematological toxicity occurred in eight ( 38.1 % ) patients . Chemotherapy response rate was : complete 0 % , partial 33.3 % and stable disease 66.7 % . Seventeen ( 80.9 % ) out of 21 patients underwent EPP with no intra or post-operative mortality with an overall major and minor morbidity rate at 52.4 % . Median survival was 25.5 months , with an overall 1 , 3 and 5-year survival rate of 71 , 33 and 19 % , respectively . CONCLUSIONS In MPM , the combined modality approach using the Carboplatin/Gemcitabine combination as induction chemotherapy is feasible , with good results in terms of survival and morbidity . Our results are similar to those of other studies using a heavier modality treatment Aprotinin has been used to decrease blood loss with complicated cardiac surgery but has not been investigated in extrapleural pneumonectomy , an operation that does not use cardiopulmonary bypass . In this prospect i ve , r and omized , placebo‐controlled , double‐blind trial , the authors investigated whether aprotinin  decreased blood loss in patients who underwent this operation Abstract Background : We analyzed morbidity and mortality , sites of recurrence , and possible prognostic factors in 95 ( 78 male , 17 female ) patients with MPM on phase I – III trials since 1990 . A debulking resection to a requisite , residual tumor thickness of ≤ 5 mm was required for inclusion . Methods : Preoperative tumor volumes were determined by three-dimensional reconstruction of chest computerized tomograms . Pleurectomy ( n=39 ) or extrapleural pneumonectomy ( EPP ; n=39 ) was performed . Seventeen patients could not be debulked . Preoperative EPP platelet counts ( 404,000 ) and mean tumor volume ( 491 cm3 ) were greater than that seen for pleurectomy ( 344,000 , 114 cm3 ) . Results : Median survival for all patients was 11.2 months , with that for pleurectomy 14.5 months , that for EPP 9.4 months , and that for unresectable patients 5.0 months . Arrhythmia ( n=14 ; 15 % ) was the most common complication , and there were two deaths related to surgery ( 2.0 % ) . Tumor volume of > 100 ml , biphasic histology , male sex , and elevated platelet count were associated with decreased survival ( p<0.05 ) . Both EPP and  pleurectomy had equivalent recurrence rates ( 27 of 39 [ 69 % ] and 31 of 39 [ 79 % ] , respectively ) ; however , 17 of 27 EPP recurrences as opposed to 28 of 31 pleurectomy recurrences were locoregional ( p2=0.013 ) . Conclusions : Debulking resections for MPM can be performed with low operative mortality . Size and platelet count are important preoperative prognostic parameters for MPM . Patients with poor prognostic indicators should probably enter nonsurgical , innovative trials where toxicity or response to therapy can be evaluated BACKGROUND The factors influencing outcome after resection of malignant pleural mesothelioma ( MPM ) are controversial . This analysis of a prospect i ve surgical data base identifies important prognostic factors . METHODS Tumors were staged by the International Mesothelioma Interest Group staging system , and patients were followed until death . Prognostic factors were analyzed by log rank and Cox regression , and were considered significant if p was less than 0.05 . RESULTS From Oct 1983 to May 1998 , 231 patients underwent thoracotomy , 115 had extrapleural pneumonectomy ( EPP ) , and 59 pleurectomy/decortication ( P/D ) . Among patients having EPP or P/D , 142 received adjuvant therapy . The median survival for stage I tumors was 29.9 months , for stage II 19 months , for stage III 10.4 months , and for stage IV 8 months . By multivariate analysis , stage , histology , gender , adjuvant therapy , but not the type of surgical resection , were significant . CONCLUSIONS The better survival previously reported for P/D compared with EPP is not seen in a large data base with long follow-up . Stages I and II have better survival rates than generally assumed for MPM . Locally advanced T and N status , and nonepithelial histology , identify poor prognosis patients who should be considered for novel treatment regimens OBJECTIVE The authors examine the feasibility and efficacy of trimodality therapy in the treatment of malignant pleural mesothelioma and identify prognostic factors . BACKGROUND Mesothelioma is a rare , uniformly fatal disease that has increased in incidence in recent decades . Single and bimodality therapies do not improve survival . METHODS From 1980 to 1995 , 120 patients underwent treatment for pathologically confirmed malignant mesothelioma at Brigham and Women 's Hospital and Dana-Farber Cancer Institute ( Boston , MA ) . Initial patient evaluation was performed by a multimodality team .  Patients meeting selection criteria and with resectable disease identified by computed tomography scan or magnetic resonance imaging underwent extrapleural pneumonectomy followed by combination chemotherapy and radiotherapy . RESULTS The cohort included 27 women and 93 men with a mean age of 56 years .  Operative mortality rate was 5.0 % , with a major morbidity rate of 22 % . Overall survival rates were 45 % at 2 years and 22 % at 5 years . Two and 5-year survival rates were 65 % and 27 % , respectively , for patients with epithelial cell type , and 20 % and 0 % , respectively , for patients with sarcomatous or mixed histology tumors . Nodal involvement was a significant negative prognostic factor . Patients who were node negative with epithelial histology had 2- and 5-year survival rates of 74 % and 39 % , respectively . Involvement of margins at time of resection did not affect survival , except in the case of full-thickness , transdiaphragmatic invasion . Classification on the basis of a revised staging system stratified median survivals , which were 22 , 17 , and 11 months for stages I , II , and III , respectively ( p = 0.04 ) . CONCLUSIONS Extrapleural pneumonectomy with adjuvant therapy is appropriate treatment for selected patients with malignant mesothelioma selected using a revised staging system PURPOSE Patients with malignant pleural mesothelioma , a rapidly progressing malignancy with a median survival time of 6 to 9 months , have previously responded poorly to chemotherapy . We conducted a phase III trial to determine whether treatment with pemetrexed and cisplatin results in survival time superior to that achieved with cisplatin alone . PATIENTS AND METHODS Chemotherapy-naive patients who were not eligible for curative surgery were r and omly assigned to receive pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 on day 1 , or cisplatin 75 mg/m2 on day 1 . Both regimens were given intravenously every 21 days . RESULTS A total of 456 patients were assigned : 226 received pemetrexed and cisplatin , 222 received cisplatin alone , and eight never received therapy .  Median survival time in the pemetrexed/cisplatin arm was 12.1 months versus 9.3 months in the control arm ( P = .020 , two-sided log-rank test ) . The hazard ratio for death of patients in the pemetrexed/cisplatin arm versus those in the control arm was 0.77 . Median time to progression was significantly longer in the pemetrexed/cisplatin arm : 5.7 months versus 3.9 months ( P = .001 ) . Response rates were 41.3 % in the pemetrexed/cisplatin arm versus 16.7 % in the control arm ( P < .0001 ) . After 117 patients had enrolled , folic acid and vitamin B12 were added to reduce toxicity , result ing in a significant reduction in toxicities in the pemetrexed/cisplatin arm . CONCLUSION Treatment with pemetrexed plus cisplatin and vitamin supplementation result ed in superior survival time , time to progression , and response rates compared with treatment with cisplatin alone in patients with malignant pleural mesothelioma . Addition of folic acid and vitamin B12 significantly reduced toxicity without adversely affecting survival time BACKGROUND The aim of this multicenter trial was to prospect ively evaluate neo-adjuvant chemotherapy followed by extrapleural pneumonectomy ( EPP ) and radiotherapy , including quality of life as outcome . PATIENTS AND METHODS Eligible patients had malignant pleural mesothelioma of all histological types , World Health Organization performance status of zero to two and clinical stage T1-T3 , N0 - 2 , M0 disease considered completely resectable .  Neo-adjuvant chemotherapy consisted of three cycles of cisplatin and gemcitabine followed by EPP . Postoperative radiotherapy was considered for all patients . RESULTS In all , 58 of 61 patients completed three cycles of neo-adjuvant chemotherapy . Forty-five patients ( 74 % ) underwent EPP and in 37 patients ( 61 % ) the resection was complete . Postoperative radiotherapy was initiated in 36 patients . The median survival of all patients was 19.8 months [ 95 % confidence interval ( CI ) 14.6 - 24.5 ] . For the 45 patients undergoing EPP , the median survival was 23 months ( 95 % CI 16.6 - 32.9 ) . Psychological distress showed minor variations over time with distress above the cut-off score indicating no morbidity with 82 % ( N = 36 ) at baseline and 76 % ( N = 26 ) at 3 months after surgery ( P = 0.5 ) . CONCLUSIONS The observed rate of operability is promising . A median survival of 23 months for patients undergoing EPP  compares favourably with the survival reported from single center studies of upfront surgery . This approach was not associated with an increase in psychological distress OBJECTIVE To report on the experience with radical surgery , with emphasis on the long-term outcome , for malignant pleural mesothelioma ( MPM ) at a single institution . METHODS From our prospect i ve data base over a  
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DISCUSSION S The current evidence suggests that selected patients with malignant pleural mesothelioma may benefit from EPP , especially when combined with neoadjuvant or adjuvant chemotherapy and adjuvant radiotherapy