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Surgery-Based Multimodal Treatment Improves Survival for Italian Mesothelioma Patients

surgery-based multimodal treatmentA new Italian report suggests that a surgery-based multimodal treatment approach to mesothelioma can help patients live longer with few serious side effects. 

The new study comes from Careggi University Hospital in Florence. Thoracic oncologists tracked the outcomes of 12 of their mesothelioma patients since 2017.

All of the patients had early-stage pleural mesothelioma of the epithelioid subtype. Results showed that none of them died within the first year after surgery-based multimodal treatment. More than half lived for at least three years. 

These are considered very positive results for a cancer that often claims lives within months of diagnosis. 

Understanding Surgery-Based Multimodal Treatment

Some types of cancer can be successfully treated with just one type of therapy. Pleural mesothelioma is not one of them. The asbestos cancer is an extremely treatment-resistant malignancy. 

To combat mesothelioma, doctors often have to use several different treatments together. Which treatments work best, and in what order, is still up for debate. 

The surgery-based multimodal treatment for mesothelioma at Careggi University Hospital includes three elements. Patients start with chemotherapy with Alimta. The goal of this neoadjuvant chemotherapy is to shrink mesothelioma tumors before surgery. 

The second element is the surgery itself. At Careggi University Hospital, surgeons use a lung-sparing procedure called pleurectomy with decortication (P/D). This approach removes as much of the cancer as possible in the chest while keeping the lungs intact. 

The third element of this surgery-based multimodal treatment is hyperthermic intraoperative thoracic chemotherapy (HITHOC). During the HITHOC procedure, doctors rinse the chest cavity with a heated solution of cisplatin. The goal is to kill any cells left behind after surgery so that they cannot spawn new mesothelioma tumors. 

Promising Results from the Three-Part Approach

The Italian team shared their results from this three-part approach in the Journal of Clinical Medicine. The hospital had seen 65 mesothelioma patients since 2017. 

Twelve of them were referred on to the surgery-based multimodal treatment approach. Doctors chose these 12 because they had early-stage mesothelioma of the epithelioid subtype and their cancer did not progress after first-line chemotherapy.   

“Post-operative mortality was 0, and complications developed in 7 patients,” writes lead study author and thoracic surgeon Stefano Bongiolatti. “The median estimated overall survival was 31 months with a 1-year and 3-year overall survival of 100% and 55%, respectively.”

Ninety-two percent of patients undergoing surgery-based multimodal treatment saw no progression of their mesothelioma for at least a year. The team concludes that this three-part approach is “well tolerated and feasible and promising mid-term oncological results.”


Bongiolatti, S, et al, “Induction Chemotherapy Followed by Pleurectomy Decortication and Hyperthermic Intraoperative Chemotherapy (HITHOC) for Early-Stage Epithelioid Malignant Pleural Mesothelioma-A Prospective Report”, Journal of Clinical Medicine, November 26, 2021, 


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