A new study has confirmed the value of the surgical approach known as extrapleural pneumonectomy (EPP) for the treatment of malignant pleural mesothelioma in select patients.
The pleural membrane separates the lungs from other internal organs. Pleural mesothelioma starts in the pleural tissue where it can cause the membrane to thicken and stiffen, restricting the ability of the lungs to expand. Eventually, the pleural cancer may metastasize into the lungs and other internal membranes. Extrapleural pneumonectomy attempts to prevent the mesothelioma cancer from further spreading to other parts of the body cavity by removing the tissues most likely to be effected.
During an extrapleural pneumonectomy, the surgeon removes part of the parietal pleura, or lung lining, as well as part of the pericardium (lining around the heart), a portion of the diaphragm, and the diseased lung. EPP is typically followed by other types of treatments, such as chemotherapy and radiation.
Now, an evaluation of thirty-four studies on extrapleural pneumonectomy from 26 institutions confirms that, for carefully selected pleural mesothelioma candidates, the procedure can prolong life and improve its quality. Reporting for an upcoming issue of the Journal of Thoracic Oncology, the Australian team that reviewed the studies found a median overall survival rate from 9.4 to 27.5 months in EPP patients. In some of the studies, as many as 83 percent of the mesothelioma EPP patients were still alive at one year post surgery, and as many as 24 percent survived at least 5 years.
“Quality of life assessments from three studies reported improvements in nearly all domains at 3 months postoperatively,” the researchers write. “Patients who underwent trimodality therapy involving EPP and adjuvant chemoradiotherapy had a median overall survival of 13 to 23.9 months.”
Research has found that patients whose mesothelioma is caught in its earliest stages, while the cancer is still contained in a fairly small area and is easily resectable, make the best candidates for EPP surgery. Patients diagnosed with the epithelioid variety of mesothelioma, rather than the sarcomatoid or biphasic varieties, also tend to respond best to extrapleural pneumonectomy.
The researchers concluded, “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.”
Cao, CQ et al, “A Systematic Review of Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma”, August 26, 2010, Journal of Thoracic Oncology (Epub ahead of print) Definition of extrapleural pneumonectomy, National Cancer Institute website, Accessed Sept. 1, 2010, Argote-Green, Luis et al, “Extrapleural pneumonectomy for malignant pleural mesothelioma”, Journal of Cardiothoracic Surgery online, Multimedia Manual of Cardiothoracic Surgery, June 28, 2005.