Women with epithelial mesothelioma who receive induction chemotherapy prior to surgery have the highest chance of benefitting from the radical surgical approach known as extrapleural pneumonectomy (EPP).
That is the conclusion reached by a team of thoracic surgeons from nine Italian medical centers. The team collected outcome and survival data on 518 malignant pleural mesothelioma patients who underwent lung-removing extrapleural pneumonectomy (EPP) surgery between 2000 and 2010.
Most of the patients in the study (84.4%) had the epithelial variety of mesothelioma, the most common subtype of pleural mesothelioma. A little over half of the study subjects had chemotherapy prior to their surgery. Known as induction or neoadjuvant chemotherapy, the goal of this treatment is to shrink mesothelioma tumors to improve the chance of complete resection.
Seventy-two percent of patients had adjuvant therapy, meaning therapy after EPP surgery, including radiotherapy (213 patients), chemotherapy (43 patients) or both (117 patients). The goal of adjuvant therapy is to destroy any mesothelioma cells that may have been left behind after surgery.
More than a quarter of the mesothelioma patients in the study developed major complications after EPP and 36 died within 90 days of the surgery. The median overall survival was 18 months with 27% of patients living to the 3-year mark. To determine what factors had the biggest impact on EPP success, the researchers performed a multivariate analysis, adjusting for age, disease stage, histology (subtype) and the use of adjuvant or neoadjuvant therapies.
“The success of EPP in the context of a multimodality treatment depends on a series of patient characteristics,” concludes lead author Lorenzo Spaggiari, MD, PhD, with the Thoracic Surgery Division of the European Institute of Oncology in Milan. “Female patients, patents with epithelial tumors, and patients who received induction chemotherapy will best benefit from EPP.”
EPP is considered the most radical type of mesothelioma surgery because it includes removal of one of the lungs as well as many other tissues at risk for mesothelioma metastasis. There remains considerable controversy in the medical community over the risks and benefits of EPP versus the lung-sparing mesothelioma surgery known as pleurectomy/decortication (P/D).
Spaggiari, L et al, “Extrapleural Pneumonectomy for Malignant Mesothelioma: An Italian Multicenter Retrospective Study”, April 11, 2014, Annals of Thoracic Surgery, Epub ahead of print