Being older does not necessarily reduce a patient’s odds of benefiting from mesothelioma surgery. That is the good news from a study conducted by mesothelioma experts at Glenfield Hospital in Leicester, England.
The bad news is that too many elderly mesothelioma patients are not being referred for adjuvant treatments that could improve their surgical outcomes.
Adjuvant Therapy and Mesothelioma Survival
Adjuvant therapy is a treatment – such as radiation or chemotherapy – that a mesothelioma patient receives after surgery. Adjuvant therapies are often used to reduce the chances that residual cancer cells will seed new mesothelioma tumors after surgery.
Neoadjuvant therapies are those that are used prior to surgery, usually as a way to reduce the size of the mesothelioma tumor to be removed.
No Difference in Hospital Stay
In a new report published in Interactive Cardiovascular and Thoracic Surgery, researchers compiled data on 282 pleural mesothelioma patients undergoing extended pleurectomy and decortication (P/D) surgery between 1999 and 2016.
The report found that, when all things were equal, most of the mesothelioma patients over 70 did as well with P/D as those under 70.
“There was no intergroup difference in length of hospital stay or in in-hospital, 30-day or 90-day mortality,” reports study author Annabel Jane Sharkey, MD, a cardiothoracic surgeon and Clinical Fellow in the Department of Cancer Studies at the University of Leicester.
Adjuvant and Neoadjuvant Therapies Improve Mesothelioma Outcomes
Extended P/D surgery is considered the less radical of the two surgical approaches to pleural mesothelioma because it leaves both lungs in place. It is still an extensive and physically taxing procedure that has sometimes been considered too risky for older patients.
But according to the report, when elderly patients did not fair as well as their younger counterparts after P/D, it was often because they were not being given the option of adjuvant or neoadjuvant therapies that might have improved their outcomes.
Only 30 percent of the mesothelioma patients over 70 had adjuvant chemotherapy while 45 percent of the younger group did. Similarly, only 11 percent of the over-70 mesothelioma patients had neoadjuvant chemotherapy, but more than 21 percent of the under-70 patients did.
Mesothelioma Survival Depends on Treatment/Patient Selection
Among those with lymph node involvement, mesothelioma patients over 70 did not live as long, especially if they had non-epithelioid tumors. The researchers conclude that optimizing P/D surgery outcomes among mesothelioma patients is more about careful patient selection and treatment choices than about age.
“Although age in isolation should not be an exclusion criterion for extended pleurectomy decortication for mesothelioma, in the elderly, a more rigorous preoperative evaluation of nodal disease and an additional assessment of fitness for adjuvant chemotherapy are recommended,” concludes Dr. Sharkey.
Sharkey, AJ, et al, “Extended pleurectomy decortication for malignant pleural mesothelioma in the elderly: the need for an inclusive yet selective approach”, November 1, 2017, Interactive Cardiovascular and Thoracic Surgery, pp. 396-702