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Combination Therapy with Mesothelioma Surgery Leads to Longer Survival

A new study finds almost a quarter of people who had combination therapy with mesothelioma surgery were still alive five years later.

The study was published in the European Journal of Cardio-Thoracic Surgery.

Researchers at University Hospitals KU Leuven in Belgium studied nearly 200 mesothelioma patients from 2003 to 2014.

Many people do not live beyond about 18 months after a mesothelioma diagnosis. But the Belgian team says, for the right patients, there is a way to improve the odds. They say combination therapy with radical mesothelioma surgery offers a 1 in 4 chance of surviving for 5 years or more.

Two Types of Mesothelioma Surgery

There are two major schools of thought about mesothelioma surgery. Some surgeons say it is best to remove as much diseased tissue as possible, including a lung, if necessary.

Other surgeons say this is too hard on patients. These doctors favor more conservative, lung-sparing surgery. People who have more conservative surgery usually have fewer complications.

The Belgian researchers focused on the more extensive, lung-removing mesothelioma surgery called EPP.

EPP is an extensive and difficult surgery. Only mesothelioma patients who were under 70 and were in otherwise good health could be in the study.

Adding Combination Therapy

The Belgian team wanted to test a specific combination of mesothelioma treatments. These included chemotherapy, followed by surgery and radiation. In the study, they call the protocol “combined modality treatment” (CMT).

Of the 197 patients in the study, 97 started with chemotherapy.

Seventy-six patients went on to have surgery. Fifty-six of those had the lung-removing EPP operation. Forty-seven mesothelioma patients finished the entire combination therapy by having radiation.

Twenty-four percent of the patients who had all three therapies survived for at least five years.

The news was even better for people with the epithelioid mesothelioma subtype. As long as the cancer had not spread to their lymph nodes, these people had a 5-year survival rate of 27 percent.

Defending EPP Surgery

More and more surgeons favor conservative mesothelioma surgery. But the Belgian study suggests there is still a place for EPP.

The researchers say the first key is to choose patients wisely.  The second is to combine EPP with other mesothelioma treatments.

Cancer centers that do a lot of mesothelioma surgeries tend to produce the best outcomes. Recommendations about surgery depend on mesothelioma type, extent, and overall health.


Frick, AE, “Combined modality treatment for malignant pleural mesothelioma: a single-centre long-term survival analysis using extrapleural pneumonectomy”, December 6, 2018, European Jouranl of Cardiothoracic Surgery, Epub ahead of print, https://academic.oup.com/ejcts/advance-article-abstract/doi/10.1093/ejcts/ezy385/5232603?redirectedFrom=fulltext

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