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Surgical Treatment in the Management of Malignant Pleural Mesothelioma: A Single Institution’s Experience

  • Thoracic Oncology
  • Published:
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Abstract

Background

A minority of patients with malignant pleural mesothelioma (MPM) are considered for surgery. To achieve a microscopically radical resection, combination with other treatment modalities is mandatory. The most effective combination is unknown. In our institute we have retrospectively analyzed the results of two combined modality regimens containing surgery.

Patients

Between January 2002 and September 2005, 15 MPM patients were treated with extrapleural pneumonectomy (EPP) and postoperative hemithoracic radiation (RT; 54 Gy). Previously, between January 1999 and December 2001, 20 patients underwent a combination of cytoreductive surgery – pleurectomy or EPP – and intraoperative hyperthermic intrathoracic chemotherapy (HITHOC), followed by radiotherapy to the thoracotomy scar and drainage tracts (24 Gy).

Results

The median operating time for EPP/RT was shorter (5.3 versus 6.9 h; P < 0.0001). Postoperative complications occurred in 8 EPP/RT patients (53%) and in 14 HITHOC patients (70%). Two HITHOC patients died postoperatively. Median overall survival was 29 months for EPP/RT patients and 11 months for HITHOC patients (P = ns). The median time to local recurrence was not reached for EPP/RT patients, and was 9 months for HITHOC patients (P = 0.003). Local control was achieved in ten EPP/RT patients (67%) with a follow-up of 5–59 months compared to four HITHOC patients (20%) with a follow-up of 4–27 months.

Conclusions

In highly selected patients local control can be achieved with combination therapy but is accompanied by a high rate of (surgical) complications. Distant failure rates warrant further studies exploring the role of systemic chemotherapy while the use of cytoreductive surgery with intraoperative chemoperfusion for MPM is not supported.

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References

  1. Robinson BW, Lake RA. Advances in malignant mesothelioma. N Engl J Med 2005;353:1591–603

    Article  PubMed  CAS  Google Scholar 

  2. Peto J, Decarli A, La Vecchia C, et al. The European mesothelioma epidemic. Br J Cancer 1999;79:666–72

    Article  PubMed  CAS  Google Scholar 

  3. Aisner J. Current approach to malignant mesothelioma of the pleura. Chest 1995;107(Suppl):332S–44S

    Article  PubMed  CAS  Google Scholar 

  4. van Ruth S, Baas P, Haas RL, et al. Cytoreductive surgery combined with intraoperative hyperthermic intrathoracic chemotherapy for stage I malignant pleural mesothelioma. Ann Surg Oncol 2003;10:176–82

    Article  PubMed  Google Scholar 

  5. de Bree E, van Ruth S, Baas P, et al. Cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy in patients with malignant pleural mesothelioma or pleural metastases of thymoma. Chest 2002;121:480–7

    Article  PubMed  Google Scholar 

  6. Rusch VW. A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group. Chest 1995;108:1122–8

    Article  PubMed  CAS  Google Scholar 

  7. Boutin C, Rey F, Viallat JR. Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma. A randomized trial of local radiotherapy. Chest 1995;108:754–8

    Article  PubMed  CAS  Google Scholar 

  8. Sugarbaker DJ, Flores RM, Jaklitsch MT, et al. Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg 1999;117:54–63

    Article  PubMed  CAS  Google Scholar 

  9. Rusch VW, Rosenzweig K, Venkatraman E, et al. A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2001;122:788–95

    Article  PubMed  CAS  Google Scholar 

  10. Aziz T, Jilaihawi A, Prakash D. The management of malignant pleural mesothelioma; single centre experience in 10 years. Eur J Cardiothorac Surg 2002;22:298–305

    Article  PubMed  Google Scholar 

  11. Lee TT, Everett DL, Shu HK, et al. Radical pleurectomy/decortication and intraoperative radiotherapy followed by conformal radiation with or without chemotherapy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2002;124:1183–9

    Article  PubMed  Google Scholar 

  12. Stewart DJ, Martin-Ucar A, Pilling JE, et al. The effect of extent of local resection on patterns of disease progression in malignant pleural mesothelioma. Ann Thorac Surg 2004;78:245–52

    Article  PubMed  Google Scholar 

  13. Richards WG, Zellos L, Bueno R, et al. Phase I to II study of pleurectomy/decortication and intraoperative intracavitary hyperthermic cisplatin lavage for mesothelioma. J Clin Oncol 2006; 24:1561–7

    Article  PubMed  CAS  Google Scholar 

  14. Pagan V, Ceron L, Paccagnella A, et al. 5-Year prospective results of trimodality treatment for malignant pleural mesothelioma. J Cardiovasc Surg (Torino) 2006;47:595–601

    CAS  Google Scholar 

  15. De Perrot M, Uy K, Anraku M, et al. Impact of lymph node metastasis on outcome after extrapleural pneumonectomy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2007;133:111–6

    Article  PubMed  Google Scholar 

  16. Sugarbaker DJ, Jaklitsch MT, Bueno R, et al. Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies. J Thorac Cardiovasc Surg 2004;128:138–46

    Article  PubMed  Google Scholar 

  17. Stewart DJ, Martin-Ucar AE, Edwards JG, et al. Extra-pleural pneumonectomy for malignant pleural mesothelioma: the risks of induction chemotherapy, right-sided procedures and prolonged operations. Eur J Cardiothorac Surg 2005;27:373–8

    Article  PubMed  Google Scholar 

  18. Chang MY, Sugarbaker DJ. Extra-pleural pneumonectomy for diffuse malignant pleural mesothelioma: techniques and complications. Thorac Surg Clin 2004;14:523–30

    Article  PubMed  Google Scholar 

  19. Allen AM, Czerminska M, Janne PA, et al. Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelioma. Int J Radiat Oncol Biol Phys 2006; 65:640–5

    PubMed  Google Scholar 

  20. Schouwink JH, Kool LS, Rutgers EJ, et al. The value of chest computer tomography and cervical mediastinoscopy in the preoperative assessment of patients with malignant pleural mesothelioma. Ann Thorac Surg 2003;75:1715–8

    Article  PubMed  Google Scholar 

  21. Rice DC, Erasmus JJ, Stevens CW, et al. Extended surgical staging for potentially resectable malignant pleural mesothelioma. Ann Thorac Surg 2005;80:1988–92

    Article  PubMed  Google Scholar 

  22. Truong MT, Marom EM, Erasmus JJ. Preoperative evaluation of patients with malignant pleural mesothelioma: role of integrated CT-PET imaging. J Thorac Imaging 2006;21:146–53

    Article  PubMed  Google Scholar 

  23. Waite K, Gilligan D. The role of radiotherapy in the treatment of malignant pleural mesothelioma. Clin Oncol (R Coll Radiol) 2007;19:182–7

    CAS  Google Scholar 

  24. Gregory DL, Fairfoul J, Chantler H, et al. Intensity modulated radiotherapy to deliver hemithorax irradiation for mesothelioma for the Mars trial. Clin Oncol (R Coll Radiol) 2007;19:S30

    CAS  Google Scholar 

  25. Vogelzang NJ, Rusthoven JJ, Symanowski J, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 2003;21:2636–44

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    J. W. van Sandick MD, PhD, I. Kappers MD & H. M. Klomp MD

  2. Department of Thoracic Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    P. Baas MD, PhD

  3. Department of Radiotherapy, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    R. L. Haas MD, PhD

Authors
  1. J. W. van Sandick MD, PhD
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  2. I. Kappers MD
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  3. P. Baas MD, PhD
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  4. R. L. Haas MD, PhD
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  5. H. M. Klomp MD
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Corresponding authors

Correspondence to J. W. van Sandick MD, PhD or H. M. Klomp MD.

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van Sandick, J.W., Kappers, I., Baas, P. et al. Surgical Treatment in the Management of Malignant Pleural Mesothelioma: A Single Institution’s Experience. Ann Surg Oncol 15, 1757–1764 (2008). https://doi.org/10.1245/s10434-008-9899-9

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  • DOI: https://doi.org/10.1245/s10434-008-9899-9

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