New research conducted in Italy and presented at the 15th World Conference on Lung Cancer in Sydney, Australia suggests that mesothelioma surgery – no matter what kind – may not offer a survival advantage over medical management for the healthiest of patients.
Mesothelioma is a rare but aggressive malignancy that is highly resistant to standard cancer treatments. The two types of mesothelioma surgery considered to be options for people with resectable cancer are pleurectomy decortication (P/D) or extrapleural pneumonectomy (EPP). While EPP is more radical than P/D because it involves removing a lung, both carry a heavy risk of complications and, according to the Italian researchers, may not be of value for certain patients.
The study reviewed data from 1,365 consecutive patients with histologically confirmed malignant pleural mesothelioma. These patients were all treated between 1982 and 2012. Of the 1,365 patients, 503 were treated with surgery. The P/D procedure was performed on 202 patients and EPP was used to treat the other 301. Some of the surgical patients also underwent chemotherapy for their mesothelioma while others did not. In order to be considered eligible for surgery, patients had to have good prognostic factors and be in overall good health.
The patients who did not undergo mesothelioma surgery either had just chemotherapy (172 patients) or best supportive care (690 patients), the goal of which is symptom management only. All patients were followed for a minimum of a year, unless they died before the year was up.
At first glance, it appears as if the patients who had surgery had better outcomes than those who did not. Mesothelioma patients who had palliative care or chemotherapy alone had a median survival of 11.7 months, the P/D patients had a median survival of 20.5 months, and the patients who underwent the more radical EPP operation had a median survival of 18.8 months. But when the numbers were compared among the patients with “favorable prognostic factors” only, the three groups had similar survival rates, each within 1 to 3 months of the others. It appears that having such favorable factors as younger age, confined tumor area, and overall good health bodes well for survival no matter what kind of treatment a patient has.
“Our data suggest that patients with good prognostic factors had similar survival whether they received medical therapy only, P/D or EPP,” the authors reported to lung cancer experts attending the Sydney conference. Because the study suggests that mesothelioma surgery provides only modest benefits, the researchers recommend further investigation of the subject in a large, multicenter, randomized clinical trial.
Bille, Andrea, et al, “Does surgery improve survival of patients with malignant pleural mesothelioma? A multicenter retrospective analysis of 1,365 consecutive patients”, October 29, 2013, Abstract of Oral Presentation, 15th Annual World Conference on Lung Cancer, International Association for the Study of Lung Cancer website.