Malignant Pleural Mesothelioma: Pleural Decortication and Multimodal Therapy

Malignant Pleural Mesothelioma: Pleural Decortication and Multimodal Therapy

Malignant pleural mesothelioma is a severe cancer caused by asbestos exposure. It impacts the lungs’ lining. Treating it is tough, as it’s aggressive and often diagnosed late.

However, new surgical and therapy methods are offering hope. A recent article looks at pleural decortication, a crucial surgery, and how multimodal therapy helps.

What is Pleural Decortication?

Pleural decortication is a surgery that removes tumors and tough lung and chest wall tissue. It’s crucial in EPD, which treats mesothelioma.

First, the surgeon removes the tumor and pleura. This allows the lung to expand fully. The surgery is methodical and exact. It ensures full tumor removal with minimal damage. Skilled thoracic surgeons in specialized centers usually perform this complex surgery.

Hyperthermic Intrathoracic Chemotherapy (HITHOC)

After removing the tumor, doctors use HITHOC. They heat chemotherapy and circulate it in the chest. This targets any remaining cancer cells.

Heating the solution boosts its cancer-killing power. Unlike regular chemotherapy, HITHOC sends high drug doses directly to the tumor. This reduces overall side effects. The procedure takes 60-90 minutes.

Multimodal Therapy: A Comprehensive Approach

Multimodal therapy combines treatments for better outcomes in pleural mesothelioma patients. It includes surgery, chemotherapy, and radiation.

Pleural decortication and EPD surgeries aim to remove as much tumor as possible. Systemic chemotherapy or HITHOC then targets any remaining cancer cells. This prevents the cancer from coming back. Post-surgery radiation can also be used. It kills any leftover cancer cells and lowers the risk of a comeback.

Benefits of Multimodal Therapy:

Multimodal therapy offers several benefits. Firstly, it boosts survival. Studies prove it extends survival in some patients with malignant pleural mesothelioma, especially those with the epithelioid subtype.

Also, it cuts recurrence. By using various treatments, it tackles cancer from different sides, making recurrence less likely. Moreover, it provides tailored treatment. Multimodal therapy allows for a personalized approach based on the patient’s condition and disease stage.

Case Study: Multimodal Therapy in Action

A recent case study showed success in treating epithelioid mesothelioma. It used an extended pleurectomy/decortication with HITHOC. The patient, treated at a specialized center, recovered well and left early.

This highlights the safety and effectiveness of multimodal therapy, especially when experts handle it.

Treating malignant pleural mesothelioma is tough. However, new surgical and therapy methods bring hope. Decortication, coupled with heated intrathoracic chemo, is promising.

Multimodal therapy, combining surgery, chemo, and radiation, improves survival and lowers the risk of relapse. As research and treatments advance, these methods will better mesothelioma outcomes.


Quiroga, Nestor Ivan, Leandro Ezequiel Grando, Xavier Michavila Oller, Pablo Luis Paglialunga, Ángela Guirao Montes, and David Sanchez-Lorente. “Malignant Pleural Mesothelioma: Description of Pleural Decortication and Hyperthermic Chemotherapy Technique in Multimodal Therapy.” Multimedia Manual of Cardiothoracic Surgery: MMCTS 2024 (May 15, 2024).

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