Surgery Extends Survival for Patients with Pleural Mesothelioma

Patients with pleural mesothelioma who choose to have surgery live longer than those who do not. This applies no matter which kind of surgery they have. 

That is the conclusion of a Mexican study published in the Annals of Oncology. Doctors with the country’s National Institute for Respiratory Diseases conducted the study. It included 122 pleural mesothelioma patients. 

The researchers analyzed a wide range of variables like age, sex, asbestos exposure, and overall health. They discovered that the decision to have surgery was one of the most important survival factors in patients with pleural mesothelioma.

Treatment Options for Patients with Pleural Mesothelioma

Pleural mesothelioma is an aggressive cancer with no known cure. It usually occurs in people who have been exposed to asbestos at work or in their environment. Asbestos fibers never leave the body. Over time, they can wreak havoc on the cells of the pleural membrane around the lungs. 

Patients with pleural mesothelioma do not have many treatment options. The primary treatment for this cancer is Alimta (pemetrexed). Patients who are healthy enough may also be recommended for surgery. 

Surgery carries its own risks. Extrapleural pneumonectomy (EPP) involves the removal of the diseased lung along with all visible traces of mesothelioma. Pleurectomy/decortication is less radical because it leaves the lungs in place. It is still a major surgery and carries the risk of serious complications. 

Benefits May be Worth the Risk

Doctors are divided over which kind of surgery is best for mesothelioma patients. Some studies show EPP is too risky for patients with pleural mesothelioma. Other studies show EPP removes cancer better than any other method. 

Patients tend to have fewer complications with P/D surgery. But some research suggests that it may leave too many mesothelioma cells behind, raising the risk for future tumors. 

But the Mexican study suggests that, in most patients with pleural mesothelioma, surgery may be the best option for longer survival.

Of the 122 pleural mesothelioma patients studied, 20 received surgery. Eight of them had EPP and eight had P/D. In four cases, doctors decided during surgery that they could not remove the tumors after all. One of the patients died within 30 days of surgery.

Survival Data Favors Surgery

The median survival among patients with pleural mesothelioma in the study was 8.6 months. But the patients who had surgery lived more than twice as long as those who did not. 

“In the surgical vs no surgical group [median survival] was 15.8 vs 7.2 months respectively,” writes lead investigator Renata Báez-Saldaña. “In comparison to no surgery treatment, surgery alone was associated with significant improvement in survival.”

Other factors that support longer survival included being female, having chemotherapy, finding cancer at an early stage, and having good overall health. 

“Our data suggest relative advantage of surgery on survival,” the report concludes. “Patients who received surgery had better survival than patients who were treated with chemotherapy or palliative care alone.”

The decision for patients with pleural mesothelioma to have surgery is highly personal. If you or someone you love has malignant mesothelioma, discuss the pros and cons of each treatment option with your doctor. In some cases, the most promising option may be a clinical trial.

Source:

Báez-Saldaña, R, et al, “Effect of surgical treatment on the survival in patients with malignant pleural mesothelioma”, Annals of Oncology, Volume 30, Supplement 2, Page ii72, https://www.annalsofoncology.org/article/S0923-7534(19)30194-2/fulltext