There is new evidence that surgery may be the most effective type of second-line treatment for malignant pleural mesothelioma.
First-line therapies for malignant mesothelioma include surgery, chemotherapy, radiation and experimental approaches such as immunotherapy.
However, the waters become murkier after mesothelioma recurrence. There is no widely-accepted second-line treatment protocol for mesothelioma.
Facts About Mesothelioma Relapse
A new study conducted at University Hospital Zurich in Switzerland reveals some important facts about the way in which mesothelioma typically recurs after treatment.
After examining the cases of 136 mesothelioma patients who underwent presurgical chemotherapy and extrapleural pneumonectomy surgery between 1999 and 2013, the team found that:
- Pleural mesothelioma usually recurs at the site of the original tumor. Seventy-nine (74%) of the 106 recurrences happened either at the original site only or at the original site and in another spot, as well
- Mesothelioma patients were less likely to experience local recurrence of their malignant mesothelioma if they had radiation after surgery, although this did not affect mesothelioma survival
- People whose mesothelioma tumors recurred only at the original spot survived a median of 5 months longer than the average for the group as a whole
Mesothelioma Survival After Second Surgery
A total of 78 of the 106 mesothelioma patients whose tumors came back after treatment elected to undergo a second-line therapy. More than half (48) had chemotherapy, 9 had radiotherapy, 10 had surgery, and 11 had a combination of these treatments.
Of these treatments, second line surgery appeared to have the greatest impact on post-recurrence mesothelioma survival (PRS).
“The median PRS after surgery was significantly longer than that of patients receiving chemo-, radio-, or chemo-radiotherapy,” writes lead author Arthur Kostron, MD. Dr. Kostron and his colleagues conclude that second-line mesothelioma treatment, especially with surgery, can offer “good long-term outcome for selected patients.”
Kostron, A, et al, “Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma”, November 20, 2015, European Journal of Cardiothoracic Surgery, Epub ahead of print