Pleurectomy/Decortication (Neo) Adjuvant Chemotherapy and Intensity Modulated Radiation Therapy to the Pleura in Patients With Locally Advanced Malignant Pleural Mesothelioma

Exclusion Criteria

• •\> 10% Sarcomatoid or desmoplastic histology
• •Continuous oxygen use
• •Prior nephrectomy on the contralateral side of MPM
• •Prior intrapleural therapy (except pleurodesis) or intrapleural therapy at the time of P/D (i.e.: intrapleural chemotherapy, photodynamic therapy, intrapleural betadine)
• •Prior thoracic radiation therapy preventing hemithoracic pleural IMRT
• •Bulky disease in the fissure preventing lung-sparing pleural IMRT
• •Patients undergoing extrapleural pneumonectomy
• •Patients with an active infection that require systemic antibiotics, antiviral, or antifungal treatments
• •Patients with a concurrent active malignancy (except squamous or basal cell carcinoma of the skin)
• •Patients with serious unstable medical illness
• •Presence of third space fluid that cannot be controlled by drainage
• •For patients who develop or have baseline clinically significant pleural effusions before or during initiation of pemetrexed therapy; consideration should be given to drain the effusion prior to chemotherapy administration
• •No acute congestive heart failure
• •Pregnant or lactating women
• •Men or women not using effective contraception
• •Reproductive risks Patients should not become pregnant or father a baby while on this study because the drugs in this study can affect an unborn baby. Women should not breast-feed a baby while on this study. Women of childbearing age will be counseled to use birth control while on this study.