A team of Swiss doctors has proposed a method of “scoring” mesothelioma patients to determine which patients are the best candidates for multimodal therapy including chemotherapy and surgery.
Multimodal therapy refers the use of several different types of mesothelioma treatments together to maximize results for patients. Therapies may include any combination of surgery, radiation, chemotherapy or newer approaches such as gene therapy or virotherapy.
In the current study, a team from University Hospital Zurich analyzed the cases of 186 Swiss mesothelioma patients treated at the hospital between 1999 and 2011. These patients had different subtypes of pleural mesothelioma and were evaluated for treatment with induction chemotherapy followed by extrapleural pneumonectomy (EPP) to remove the diseased pleura and closest lung.
Of the 186 patients considered for surgery, a total of 128 ended up undergoing the chemotherapy/EPP approach resulting in a 30-day mortality rate of 4.7%. Just over half of the patients also received radiotherapy after surgery. The team found that patients treated with EPP on average survived twice as long as those who did not undergo surgery.
“Patients receiving induction chemotherapy followed by EPP for malignant pleural mesothelioma of all histological subtypes and irrespective of nodal status showed a median survival of 22 months,” writes study author Isabelle Opitz, MD, with the University Hospital Zurich Division of Thoracic Surgery.
Based on these results, the researchers came up with a way to “score” future mesothelioma patients to make it easier for doctors to decide which patients should have surgery and which are unlikely to benefit. The proposed prognostic scoring system took into account tumor volume, histological subtype, response to chemotherapy and other factors.
Their findings and proposed prognostic scoring index were published in the Journal of Thoracic Oncology.
Opitz, I, “A new prognostic score supporting treatment allocation for multimodality therapy for malignant pleural mesothelioma- A review of 12 years’ experience”, August 27, 2015, Journal of Thoracic Oncology, Epub ahead of print.