***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: There is no st and ard treatment for patients with pleural malignancies . The aim of this prospect i ve study was to investigate the toxicity and long-term results of a multimodality treatment consisting of surgery and intrathoracic chemohyperthermia ( ITCH ) for the treatment of patients with pleural malignancies . From January 1990 to August 2000 , 24 patients with mesothelioma ( n=17 ) , fibrosarcoma ( n=3 ) , pleural adenocarcinoma ( n=3 ) and thymoma ( n=1 ) were included . The mesothelioma stages were T1 or T2 in 10 cases , and T3 or T4 in seven cases . After cytoreductive surgery , ITCH was carried out for over 60 min , at inflow temperatures less than 45 ° C , either with mitomycin C ( n=7 ) or cisplatin ( n=5 ) or both ( n=12 ) . One patient died from major thoracic air leaks after major decortication and pleurectomy . Seven patients had complications , one pleural clotting necessitating reoperation . After a median follow-up of 89 months , the overall 1-year and 5-year survival rates were 74 and 27 % , respectively . For T1 and T2 mesothelioma patients , the median survival was 41.3 months , and for T3 and T4 tumours , it was 4.5 months ( P=0.001 ) . The fibrosarcoma patients are alive with no evidence of recurrence at 24 , 43 and 54 months . In the conclusion , the combination of surgery with ITCH with mitomycin and /or cisplatin  is relatively safe . This procedure may offer unexpected long-term survival in a selected group of patients ( T1 and T2 mesothelioma patients and fibrosarcoma patients ) Malignant pleural mesothelioma ( MPM ) is a rare tumour but with increasing incidence and a poor prognosis . In 2008 , the European Respiratory Society/European Society of Thoracic Surgeons Task Force brought together experts to propose practical and up-to- date d guidelines on the management of MPM . To obtain an earlier and reliable diagnosis of MPM , the experts recommend performing thoracoscopy , except in cases of pre-operative contraindication or pleural symphysis . The st and ard staining procedures are insufficient in ∼10 % of cases . Therefore , we propose using specific immunohistochemistry markers on pleural biopsies . In the absence of a uniform , robust and vali date d staging system , we advice use of the most recent TNM based classification , and propose a three step pre-treatment assessment . Patient 's performance status and histological subtype are currently the only prognostic factors of clinical importance in the management of MPM . Other potential parameters should be recorded at baseline and reported in clinical trials . MPM exhibits a high resistance to chemotherapy and only a few patients are c and i date s for radical surgery . New therapies and strategies have been review ed . Because of limited data on the best combination treatment , we emphasise that patients who are considered c and i date s for a multimodal approach should be included in a prospect i ve trial at a specialised centre Abstract Background : Patients with malignant pleural mesothelioma ( MPM ) usually die of progressive local disease . This report describes the results of a Phase III trial comparing maximum debulking surgery and postoperative cisplatin , interferon α-2b , and tamoxifen ( CIT ) immunochemotherapy with and without intraoperative photodynamic therapy ( PDT ) to determine ( 1 ) whether such a multimodal approach can be performed with minimum morbidity and mortality in malignant pleural mesothelioma ( MPM ) , and ( 2 ) whether first-generation ( i.e. , 630-nm laser light , Photofrin II ) intrapleural PDT impacts on local recurrence or survival . Methods : From July 1993 to June 1996 , 63 patients with localized MPM were r and omized to either PDT or no PDT .  The tumors of 15 patients could not be debulked to 5 mm . Patients assigned to PDT ( n=25 ) and no PDT ( n=23 ) were similar with respect to age , sex , tumor volume , and histology . Results : The type of resection ( 11 pleurectomies and 14 pneumonectomies vs. 12 pleurectomies and 11 pneumonectomies ) , length postoperative stay , and ICU time were comparable ( PDT vs. no PDT ) . There was one operative death ( hemorrhage ) , and each group had two bronchopleural fistulas . Postoperative staging divided patients into the following categories : stage I : PDT , 2 , no PDT , 2 ; stage II : PDT , 2 , no PDT , 2 ; stage III , PDT , 21 ; no PDT , 17 ; stage IV , PDT , 0 ; 0 ; no PDT , 2 . Comparable numbers of CIT cycles were delivered . Median survival for the 15 non-debulked patients was 7.2 months , compared to 14 months for the 48 patients on protocol . There were no differences in median survival ( 14.4 vs. 14.1 months ) or median progression-free time ( 8.5 vs. 7.7 months ) , and sites of first recurrence were similar . Conclusions : Aggressive multimodal therapy can be delivered for patients with higher stage MPM . First-generation PDT does not prolong survival or increase local control for MPM Malignant pleural mesothelioma ( MPM ) is a generally fatal disease with no st and ard treatment . There are encouraging reports using intraperitoneal chemotherapy to treat peritoneal mesotheliomas and intrapleural chemotherapy ( IPC ) to treat malignant pleural effusions . Our objective was to evaluate the efficacy of IPC after subtotal pleurectomy . Between 1988 and 1992 , 20 consecutive patients with diffuse MPM limited to one hemithorax underwent subtotal pleurectomy . Thirteen patients with biopsy-proven MPM known prior to thoracotomy were enrolled in a phase II combined modality protocol consisting of perioperative intrapleural cisplatin ( 100 mg/m2 ) and ara-C ( 1,200 mg ) after subtotal pleurectomy , followed by systemic cisplatin ( 50 mg/m2/week x 8) and mitomycin-C ( 8 mg/m2 , days 1 and 36 ) . Seven patients with MPM could not be enrolled because their diagnosis was made post-thoracotomy . These patients underwent subtotal pleurectomy with ( n = 4 ) or without ( n = 3 ) adjuvant radiation ( 4,500 - 5,000 cGy in 3 patients , 2,100 cGy in 1 patient ) . One of three patients who developed chemotherapy-related nephrotoxicity died , the only treatment-related mortality . All 3 patients requiring postoperative readmission received IPC . Significant morbidity did not occur in patients not receiving chemotherapy . Median survival and time to progression were significantly longer in patients not receiving IPC ( 21 vs. 9 months , P = 0.04 ; 12 vs. 6 months , P = 0.01 ) . In conclusion , intrapleural and postoperative systemic chemotherapy result ed in significant toxicity and did not improve survival in our patients who underwent subtotal pleurectomy for MPM We have carried out sequential prospect i ve studies of treatment with surgery alone , chemotherapy , and radiotherapy in malignant mesothelioma of the pleura . The survival of treated patients was contrasted with that of 64 contemporary untreated patients whose clinical condition at presentation was comparable with that of the treated patients .  Non-radical surgery alone ( 28 patients ) was of palliative benefit , particularly for the control of recurrent pleural effusions , and may have prolonged survival in one patient with localised malignant mesothelioma .  Chemotherapy with doxorubicin , vincristine , and cyclophosphamide ( 12 patients , with preceding surgery in eight ) was without objective benefit . Megavoltage radiotherapy by an off axis beam rotational technique ( 12 patients , with preceding surgery in eight ) abolished pain and dyspnoea and may have prolonged survival in one patient and terminated recurrent pleural effusions in three , but it was of no value in the other patients . There was no significant difference in survival between treatment groups or between treated and untreated patients , and no difference when mesotheliomas of epithelial , sarcomatous , and mixed cell types were examined separately . Treatment of this disease appeared to fail because of the unresponsiveness of the tumour to existing forms of treatment and the advanced stage of the disease at clinical presentation One-hundred and twenty-one cases of malignant pleural mesothelioma ( MPM ) seen between 1986 and 1999 at the authors ' Institution were review ed . Histotype was epithelial in 88 patients ( 73 % ) , sarcomatous in 21 ( 17 % ) and mixed in 12 ( 10 % ) . Ninety-one patients received a treatment  ( 38 palliative pleurectomy and no further therapy , 16 palliative pleurectomy followed by chemotherapy , 37 chemotherapy alone )  , while 30 were referred to supportive care only .  Median survival of the whole population was 10.5 months . The 1- , 2- and 3-year survival were 40 , 17 and 8 % , respectively . Univariate analysis of subgroups showed that poor performance status ( PS ) , non-epithelial histotype , Butchart stage > I and International Mesothelioma Interest Group ( IMIG ) stage > I were individually associated with lower survival . Patients receiving any therapy survived longer than patients treated with supportive care only ( P=0.0004 ) . Treatment modality had an independent prognostic value ( P=0.00005 ) , with a survival advantage for patients receiving surgery and adjuvant chemotherapy . Multivariate analysis confirmed the independent prognostic value of PS ( P=0.001 ; HR=2.48 ) and treatment modality ( P=0.003 ; HR=1.38 ) . The prognostic role of PS ( P=0.02 ) and treatment modality ( P=0.01 ) was confirmed in the subset of patients with epithelial histology . On the contrary , therapy had no impact on survival in patients with sarcomatoid MPM ( P=0.74 ) . Despite the predicted bias of a retrospective non-r and omized evaluation of treatment-related factors , patients with good PS and epithelial histology seemed to have a survival benefit from surgery or multimodality therapy , as opposite to patients with poor PS or non-epithelial histotype . However , these results must be confirmed in a larger prospect i ve trial with uniform treatment OBJECTIVES Mesothelioma is an increasingly frequent malignancy in which diagnosis is often delayed and disease diagnosed at an advanced stage . Earlier diagnosis and therapeutic intervention that can control recurrent pleural effusion may improve outlook and survival . METHODS A prospect i ve series of 25 patients in whom mesothelioma was suspected was referred for histological diagnosis by video assisted-thoracoscopy ( VAT )  after failure of other methods . At the same operative procedure drainage of pleural effusion , cytoreductive pleurectomy and lung mobilization was performed where possible . Complete follow-up was obtained . RESULTS All patients had a histological diagnosis ( 100 % ) from the material sent for biopsy . In 23 patients this was mesothelioma , in two patients chronic empyema . All patients undergoing drainage of effusion , cytoreductive pleurectomy and lung mobilization subsequently were diagnosed of having mesothelioma stages III to IV . Fifteen out of 21 who underwent lung mobilization had closure of the pleural space . Post operative air leak in this group was a mean of 5 days ( 2 - 12 days ) . Recurrent effusion occurred in only one patient . Eleven patients remain alive at 1 - 2 years post operation with no hospital admissions for recurrent pleural effusion . In the six out of 21 who did not have closure of the pleural space , one remained alive 9 months post surgery . Five died within 1 - 6 months of the procedure . The average number of further hospital admissions for repeat drainage of effusion was 3 ( 1 - 6 ) . CONCLUSIONS VATs provides adequate tissue for histological diagnosis where other methods fail . At the same operative sitting it provides a therapeutic intervention that allows drainage of effusion cytoreductive pleurectomy and lung mobilization in a significant number of cases . Where the pleural space can be closed this results in significantly fewer hospital admissions and appears to improve quality of life and length of survival . The price is a longer hospital stay due to prolonged air leak Background : Treatment approaches in malignant pleural mesothelioma ( MPM ) patients range from mere palliation to aggressive anticancer therapy , and there is currently no consensus on the optimal therapeutic strategy . In 1999 , we began a phase II study to investigate four-modality treatment of advanced stage MPM . Methods : From 1999 to 2004 , 49 patients with International Mesothelioma Interest Group stage II – III MPM underwent four-modality treatment with intrapleural preoperative interleukin-2 ( 18 × 106 UI/day for 3 days ) , pleurectomy/decortication , intrapleural postoperative epidoxorubicin ( 25 mg/m2 for 3 days ) , interleukin-2 ( 18 × 106 UI/day for 3 days ) , adjuvant radiotherapy ( 30 
    Output:
    
Conclusions In the absence of any form of control data , no conclusions can be drawn concerning survival differences or symptomatic benefits attributable to surgery .