Prolonged survival after multimodal therapy for pleural mesothelioma: Don't give up the follow-up. A case report

Our plain-English summary of Prolonged survival after multimodal therapy for pleural mesothelioma: Don't give up the follow-up. A case report, by J. Guinde, B. Chollet, S. Laroumagne, et al (Annals of Medicine and Surgery, 2020).

The study

• Authors: J. Guinde, B. Chollet, S. Laroumagne, H. Dutau, P. Astoul
• Journal: Annals of Medicine and Surgery
• Published: 2020;60:442-444
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant Pleural mesothelioma (MPM) is a rare disease which is associated with a poor prognosis. Front line chemotherapy represents the cornerstone in the management of MPM, and the place of radical surgery is controversial and reserve in early-stage disease. However prolonged survival (more than 24 months) can be observed in rare cases and only in the context of multimodal treatment including surgical management. We report the case of a patient suffering from an epithelial MPM with a 14-years progression-free survival after trimodal treatment including extrapleural pneumonectomy followed by chemotherapy and radiotherapy. This case illustrates that despite being an aggressive disease, multimodal management including radical surgery may allow a prolonged response in MPM but requires a whole-life surveillance.

© 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

In plain English

This article was a case report about one patient treated at a hospital in Marseille, France. A 68-year-old man with a past history of asbestos exposure was diagnosed in August 2004 with malignant pleural mesothelioma of the epithelial type, after fluid had built up around his left lung. The article gave no details of the exposure or the fiber type. His disease was judged stage II. In October 2004 he had an extrapleural pneumonectomy, and the surgeons judged that no tumor was left behind. He then received chemotherapy (raltitrexed and oxaliplatin) and 65 Gy of radiotherapy to the affected side of the chest, with mild blood-related side effects. In early 2018, at age 81, a scan and a needle biopsy showed the mesothelioma had returned. Chemotherapy with carboplatin and pemetrexed kept the disease stable for 10 months before it progressed again, and palliative care was decided. The authors concluded that combined treatment including radical surgery can lead to a complete and prolonged response, and that late recurrence makes whole-life surveillance necessary.

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: case report of a single patient
• Who was studied: one 68-year-old man with a past history of asbestos exposure, diagnosed in August 2004 and treated at the Department of Thoracic Oncology, Hôpital Nord, Marseille, France
• Exposure: past history of asbestos exposure; no fiber type, job, product or dose is given
• Main results:
  • The patient had malignant pleural mesothelioma of epithelial type, found after a left pleural effusion. The clinical stage was considered IMIG stage II.
  • The patient had an extrapleural pneumonectomy in October 2004. It confirmed stage T2N0, and the resection was considered R0 (no tumor left behind).
  • After surgery the patient received chemotherapy with raltitrexed (3 mg/m2) and oxaliplatin (130 mg/m2), one cycle before and three cycles after radiotherapy. The radiotherapy was 65 Gy to the involved hemithorax over 6 weeks.
  • The patient's chemotherapy caused mild hematologic toxicity and no hair loss.
  • At the start of 2018, a PET scan in this patient showed nodular thickening of the left costo-diaphragmatic junction. A needle biopsy was consistent with malignant mesothelioma of epithelial sub-type.
  • The patient, then 81, received carboplatin and pemetrexed every 21 days for 6 cycles. The disease was stable for 10 months, then progressed, and palliative care was decided.
• The authors' conclusion: The authors concluded that a multimodal approach including radical surgery can lead to a complete and prolonged response in malignant pleural mesothelioma. They added that recurrence can occur after a long period, so whole-life surveillance is necessary.

Topics

Medical terms in this study, explained in our Lexicon: Multimodal Therapy, Pleural Mesothelioma, Prognosis, Chemotherapy, Progression-Free Survival, Extrapleural Pneumonectomy (EPP).

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• Survival Effect of Complete Multimodal Therapy in Malignant Pleural Mesothelioma — M. Sayan, A. Bas, et al. (2022)
• Impact of Multimodal Surgical Resection and Personalized Targeted Therapy on Survival Outcomes in Early-Stage Malignant Pleural Mesothelioma: A Meta-Analysis — A.Q. Vega Morales, J.L. Rivera Gastelum, et al. (2025)
• Multimodal therapy of malignant pleural mesothelioma: is the replacement of radical surgery imminent? — J. Lindenmann, V. Matzi, et al. (2013)
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