Multimodal treatment for resectable epithelial type malignant pleural mesothelioma

Our plain-English summary of Multimodal treatment for resectable epithelial type malignant pleural mesothelioma, by I. Yoshino, M. Yamaguchi, T. Okamoto, et al (World Journal of Surgical Oncology, 2004).

The study

• Authors: I. Yoshino, M. Yamaguchi, T. Okamoto, C. Ushijima, Y. Fukuyama, Y. Ichinose, Y. Maehara
• Journal: World Journal of Surgical Oncology
• Published: 2004;2:11
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma is a rare malignancy. The outcome remains poor despite complete surgical resection.

Patients And Methods: Eleven patients with histologicaly proven epithelial type malignant pleural mesothelioma undergoing extrapleural pneumonectomy with systemic chemotherapy and/or radiotherapy before and after surgical resection were retrospectively reviewed.

Results: Ten out of 11 patients underwent complete surgical resection, of these 7 patients had stage I disease. Of these 7 patients, 5 are alive without any recurrence, a 2-year survival rate of 80% was observed in this group. There was no operative mortality or morbidity.

Conclusion: Extrapleural pneumonectomy with perioperative adjuvant treatment is safe and effective procedure for epithelial type malignant pleural mesothelioma.

In plain English

This Japanese study looked back at patients treated between 1995 and 2002 for epithelial type malignant pleural mesothelioma. All had extrapleural pneumonectomy (removal of the lung and its lining) plus chemotherapy and/or radiotherapy before or after surgery. The article does not describe asbestos exposure. Its patient count is inconsistent: the abstract and table list 11 patients, while the methods say 10. The authors reported no surgical complications or deaths, although the table records one patient whose tumor was incompletely removed and who died at 1 month. Six patients relapsed in the chest. Brigham and Women's Hospital stage I patients (7 per the abstract and table, 6 per the methods and discussion) had 80% two-year survival, versus 37% for 4 patients at stages II to III. In 3 patients given chemotherapy before surgery, tumors shrank by 18 to 74%. All 3 patients given chemotherapy after surgery developed grade 4 neutropenia, a severe drop in infection-fighting white blood cells. The authors concluded the combined treatment was safe and effective. They said preoperative chemotherapy followed by surgery still needs testing in a randomized controlled trial.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective review of a small case series of surgically treated patients (treatment outcome study)
• Who was studied: Patients with epithelial type malignant pleural mesothelioma treated between 1995 and 2002. The authors are from Kyushu University and the National Kyushu Cancer Center, Fukuoka, Japan. The methods say 10 patients, but the abstract and table list 11. The table shows ages 48 to 66, 9 men and 2 women.
• Exposure: Not an asbestos exposure study, and no asbestos exposure is reported. The treatment studied was extrapleural pneumonectomy combined with one of three regimens: preoperative cisplatin with 40 Gy hemithorax radiotherapy; preoperative cisplatin, gemcitabine and vinorelbine; or postoperative cisplatin, gemcitabine and UFT (tegafur/uracil).
• Main results:
  • The authors reported that no patient had complications or died after the operation.
  • The table lists one patient (Case 3, incomplete resection) as having died at 1 month.
  • Six patients relapsed in the chest.
  • One patient had chest wall surgery for a recurrence 12 months after the operation.
  • Five patients (Cases 5, 6, 8, 9 and 11) were reported as surviving without any disease.
  • The abstract states that 7 of the 10 completely resected patients had stage I disease, and that 5 of these 7 were alive without recurrence. The methods and discussion instead give 6 stage I patients.
  • Patients with Brigham and Women's Hospital (BWH) stage I disease had 80% survival at 2 years.
  • The 4 patients with BWH stage II to III disease had 37% survival at 2 years.
  • All 3 patients given postoperative chemotherapy, started 2 to 3 months after surgery, had grade 4 neutropenia. One also had grade 3 loss of appetite.
  • In the 3 patients given preoperative chemotherapy, tumors shrank by 18 to 74%.
  • In those same 3 cases, the removed tissue showed extensive fibrosis with only a small focus of tumor cells.
  • In Case 10, a suspected recurrence turned out to be liver herniating through the defect in the reconstructed diaphragm.
  • The authors reported that BWH stage predicted prognosis well, while IMIG stage did not.
• The authors' conclusion: The authors concluded that extrapleural pneumonectomy with perioperative adjuvant treatment is a safe and effective procedure for epithelial type malignant pleural mesothelioma. They suggested that preoperative chemotherapy followed by surgery is effective and safe.
• Limitations the authors state:
  • The authors stated that preoperative chemotherapy followed by surgery needs to be tested in a randomized controlled trial.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Surgical Resection, Extrapleural Pneumonectomy (EPP), Chemotherapy.

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• Multimodal Treatment of Pleural Mesothelioma with Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy: Impact of Additive Chemotherapy — L.V. Klotz, J. Zimmermann, et al. (2024)
• Outcomes of the Multimodal Treatment of Malignant Pleural Mesiothelioma: The Role of Surgery — B.S. Na, J.S. Kim, et al. (2018)

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