Chemotherapy & Surgery – Brigham and Women’s Hospital
This fascinating treatment published in 2009 was designed to use heated chemotherapy immediately after surgery. After pleural mesothelioma patients were given an extrapleural pneumonectomy (EPP), heated chemo was placed directly in the area where the tumor had been. The idea was to put the chemo directly in contact with any remaining cancer cells. This approach is very similar to the HIPEC procedure used in peritoneal mesothelioma.
The type of heated chemotherapy used was cisplatin, which is a standard chemo in mesothelioma. It was heated to 107.6 degrees Fahrenheit and placed in the surgical cavity for an hour.
There were a total of 121 patients involved in this study. Ninety-six received the EPP and 92 also were given the heated chemo.
The doctors reported that 4.3% of the patients died in the hospital. The median survival of the 121 pleural mesothelioma patients was 12.8 months.
There were a number of side-effects from EPP and heated chemotherapy including: atrial fibrillation, venous thrombosis, and renal toxicity.
Even though there were patient deaths and strong side effects, the doctors concluded that this treatment “can be performed with acceptable morbidity and mortality.”
Patients: This phase 2 study involved 92 patients with malignant pleural mesothelioma. The majority (79%) were men. Their median age was 60, ranging from 27 to 78 years of age.
Treatment: Patients were treated with a combination of chemotherapy and surgery, called an extrapleural pneumonectomy followed by intracavitary intraoperative hyperthermic cisplatin with pharmacologic cytoprotection. Cisplatin is the chemotherapy drug that was given.
Toxicity: Four of the treated patients died. One died within 30 days of the operation from organ failure after a heart attack. Three patients died during the time shortly after surgery while they were recovering in the hospital. Grade 4 toxicities included atrial fibrillation, thrombosis or embolism, respiratory failure, cardiac ischemia, kidney failure, and enteric fistula.
Results: The median overall survival was 13.1 months for the patients receiving the surgery treatment.
Correspondence: Dr. David Sugarbaker
See all conventional treatment results for mesothelioma.