Conservative Surgery Leads to Better Mesothelioma Survival After Recurrence

Mesothelioma survival after recurrence may be better with lung-preserving P/D surgery than with more radical EPP.

Japanese researchers recently analyzed the cases of 44 mesothelioma patients who underwent either EPP or P/D.

It took about the same amount of time for mesothelioma tumors to start growing again, no matter what type of surgery the patient had. The difference was in survival.

Both overall survival and mesothelioma survival after recurrence were longer in the P/D patients.

EPP vs. P/D: The Ongoing Debate

Mesothelioma surgeons around the world are still divided about which type of mesothelioma surgery is best.

On one hand, extrapleural pneumonectomy (EPP) removes more diseased tissue, including a lung. Some say this improves the odds of long term mesothelioma survival. There are fewer spots for mesothelioma to recur.

But EPP carries a high risk of complications and even death. A growing number of doctors favor pleurectomy with decortication (P/D). It is easier to perform and less traumatic for patients. Patients may also breathe better after P/D than after EPP.

Now, doctors at Hiroshima University say P/D is also the best procedure to improve mesothelioma survival after recurrence.

First-Line and Second-Line Mesothelioma Treatments

Chemotherapy with pemetrexed (Alimta) and a platinum drug is the only FDA-approved first-line treatment for mesothelioma. Chemotherapy may be followed by surgery to remove as much malignant mesothelioma as possible.

If a mesothelioma tumor comes back, the options are even fewer. There are no approved second-line treatments to extend mesothelioma survival after recurrence. Patients and their doctors have to make the best choice they can, based on the individual case.

Analyzing Mesothelioma Survival After Recurrence

The Hiroshima University study included 29 EPP patients and 15 P/D patients.

Many other studies show that patients with epithelial mesothelioma have the best survival odds. But the new study finds that, even among epithelial patients, those who had EPP experienced shorter mesothelioma survival after recurrence.

“Post-recurrence survival (PRS) among all patients was significantly longer in the P/D group even among patients with epithelial-type malignant pleural mesothelioma,” says study author Yuichiro Kai with the Research Institute for Radiation Biology and Medicine.

Mesothelioma Survival After Recurrence By the Numbers

Median mesothelioma survival after recurrence for epithelial patients who had EPP surgery was six months. In contrast, epithelial patients who had P/D had a median survival after recurrence of 20 months.

Only 8 percent of these EPP patients were still alive a year-and-a-half later. But 61 percent of the P/D epithelial patients were still living at that point.

Among all the mesothelioma types represented, the median overall mesothelioma survival after EPP was 17 months versus 34 months in the P/D group. People who had chemotherapy after recurrence lived the longest.

“In summary, P/D may be an alternative procedure to EPP for resectable malignant pleural mesothelioma, providing similar progression-free survival and improved PRS,” says Dr. Kai.

Source:

Kai, Y, et al, “Prolonged post-recurrence survival following pleurectomy/decortication for malignant pleural mesothelioma”, March 2019, Oncology Letters, https://www.spandidos-publications.com/10.3892/ol.2019.9979