For people with malignant pleural mesothelioma, surgery often offers the best odds of survival. But surgery can also come at a heavy cost in terms of pain, post-surgical side effects, and quality of life.
Even lung-sparing pleurectomy with decortication, the least radical of the two major types of mesothelioma surgery, can cause life-threatening complications.
But a new Italian study suggests that it may be possible to minimize side effects and maximize mesothelioma survival by using a modified version of pleurectomy followed by a specialized chemotherapy treatment.
Pleurectomy for Treatment of Pleural Mesothelioma
During a typical extended pleurectomy for a patient with pleural mesothelioma, surgeons remove the diseased pleural membrane where mesothelioma tumors grow.
In an effort to keep mesothelioma from spreading, the surgeon will also typically remove other at-risk tissues including all or part of the diaphragm and the pericardium, the membrane that surrounds the heart.
Although pleurectomy (even the radical version) is less extensive than lung-removing extrapleural pneumonectomy surgery (EPP), it still carries a risk of serious postoperative problems, pain, and even death.
A Safer Option for Mesothelioma Surgery?
The newly released mesothelioma surgery study began in 2005 and included 49 pleural mesothelioma patients, most of whom were men with the epithelioid subtype of mesothelioma. Almost half of the patients had been diagnosed with Stage III or IV mesothelioma.
Over ten years, these malignant pleural mesothelioma patients were treated with a version of pleurectomy that spared not only their lungs, but also their diaphragm and pericardium.
After the surgery, each patient’s chest area was rinsed with a solution of heated chemotherapy drugs in a procedure known as HITHOC (hyperthemic intrathoracic chemotherapy). Patients also underwent standard mesothelioma chemotherapy afterward.
Modified Pleurectomy and HITHOC for Mesothelioma Treatment
The best news was that there were no intraoperative complications or postoperative deaths among any of the study participants. Fewer than half experienced any complications after the modified pleurectomy with HITHOC.
The overall mesothelioma survival rate after the procedure was just under two years, but almost ten percent of the mesothelioma patients treated with this combination lived for at least five years afterward. Almost 80 percent lived for at least a year and 45.7 percent experienced two years of mesothelioma survival.
“Cytoreductive surgery associated with HITHOC and adjuvant chemotherapy appears feasible and safe, with no mortality and low morbidity,” concludes study author Marcello Carlo Ambrogi, PhD. “Preserving lung and diaphragmatic function might warrant an acceptable long-term outcome.”
The new study appears in the Journal of Thoracic and Cardiovascular Surgery.
Ambrogi, MC, et al, “Diaphragm and lung-preserving surgery with hyperthermic chemotherapy for malignant pleural mesothelioma: A 10-year experience”, November 1, 2017, Journal of Thoracic and Cardiovascular Surgery, Epub ahead of print