Survival of pleurectomy-decortication and hyperthermic chemotherapy in mesothelioma

Our plain-English summary of Survival of pleurectomy-decortication and hyperthermic chemotherapy in mesothelioma, by A.G. Ergönül, S. Aydın, S. Kahraman Aydın, et al (Türk Göğüs Kalp Damar Cerrahisi Dergisi, 2023).

The study

• Authors: A.G. Ergönül, S. Aydın, S. Kahraman Aydın, T.İ. Akçam, A. Özdil, K. Turhan, A. Çakan, U. Çağırıcı
• Journal: Türk Göğüs Kalp Damar Cerrahisi Dergisi
• Published: 2023;31(3):381-387
• Read it: PubMed · Publisher · Free full text

Abstract

Background: This study aims to evaluate overall survival, diseasefree survival, and prognostic factors in patients undergoing pleurectomy-decortication and hyperthermic intrathoracic chemotherapy with the diagnosis of malignant pleural mesothelioma.

Methods: Between January 2020 and November 2021, a total of 53 patients (27 males, 26 females; mean age: 58.1±1.3 years; range, 39 to 81 years) who underwent pleurectomy-decortication and hyperthermic intrathoracic chemotherapy with the diagnosis of malignant pleural mesothelioma were retrospectively analyzed. Data including characteristics, comorbidities, postoperative complications, recurrence and mortality status of the patients were recorded. Overall survival and disease-free survival and prognostic factors were evaluated.

Results: The median disease-free survival was 11.67 months and the median overall survival was 24.60 months. The median disease-free survival was 8.80 months in men and 13.17 months in women, indicating a statistically significant difference as it showed that recurrence was detected earlier in male patients (p=0.037). The median disease-free survival and overall survival was 6.13 months and 11.70 in cases diagnosed with biphasic mesothelioma, respectively, while it was 11.67 months and 25.46 months in cases with epithelial mesothelioma, respectively. Pathological subtype was found to be an effective prognostic factor for both survival (p=0.049 and p<0.001, respectively).

Conclusion: Hyperthermic intrathoracic chemotherapy following cytoreductive surgery is a preferable and tolerable method in the treatment of malignant pleural mesothelioma. While evaluating surgical indications, it should be kept in mind that cases with epithelial mesothelioma may benefit more from surgical treatment.

Copyright © 2023, Turkish Society of Cardiovascular Surgery.

In plain English

This single-center, retrospective study reviewed 53 patients (27 men, 26 women; mean age 58.1 years) with malignant pleural mesothelioma treated at Ege University, Izmir, Türkiye, between January 2020 and November 2021. All had pleurectomy-decortication surgery followed by heated cisplatin chemotherapy inside the chest (hyperthermic intrathoracic chemotherapy). Median disease-free survival was 11.67 months (95% CI 9.33 to 14.01) and median overall survival 24.60 months (95% CI 16.24 to 32.96). Recurrence came earlier in men (median 8.80 months, 95% CI 5.77 to 11.83) than women (13.17 months, 95% CI 9.42 to 16.91; p=0.037), but sex did not significantly affect overall survival. Median overall survival was 11.70 months (95% CI 8.65 to 14.75) in the 8 patients with biphasic mesothelioma and 25.46 months (95% CI 14.15 to 36.78) in the 45 with epithelial mesothelioma (p<0.001). Stage was not a significant factor for either measure. The overall complication rate was 71.7%. The authors concluded that the combined treatment is preferable and tolerable when care before and after surgery is appropriate. They noted the lack of a control group and called for further well-designed studies.

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: Single-center retrospective study (case series) with no control group
• Who was studied: 53 patients (27 males, 26 females; mean age 58.1 years, range 39 to 81) with malignant pleural mesothelioma who were non-metastatic and resectable, treated at the Department of Thoracic Surgery, Ege University School of Medicine, Izmir, Türkiye, between January 2020 and November 2021
• Exposure: Treatment studied (not asbestos exposure): total pleurectomy-decortication followed by hyperthermic intrathoracic chemotherapy with cisplatin at 150 mg per square metre, given for 1 hour at 41°C. The study did not measure individual asbestos exposure. Because asbestos-containing soils are used in homes in some regions of Türkiye, the authors recorded where patients were born and lived.
• Main results:
  • Median disease-free survival for all 53 patients was 11.67 months (range 2.6 to 53.2; 95% CI 9.33 to 14.01)
  • Median overall survival for all 53 patients was 24.60 months (range 2.6 to 135.6; 95% CI 16.24 to 32.96)
  • Median disease-free survival was 8.80 months (95% CI 5.77 to 11.83) for males and 13.17 months (95% CI 9.42 to 16.91) for females. The authors reported male sex as a factor in recurrence (p=0.037).
  • Sex was not a significant factor for overall survival (p=0.14)
  • Of the 53 patients, 45 (84.9%) had epithelial and 8 (15.1%) had biphasic mesothelioma
  • Median disease-free survival was 6.13 months (95% CI 4.34 to 7.93) in biphasic cases and 11.67 months (95% CI 8.65 to 14.68) in epithelial cases. The authors described this as statistically significant but a weak relationship (p=0.049).
  • Median overall survival was 11.70 months (95% CI 8.65 to 14.75) in biphasic cases and 25.46 months (95% CI 14.15 to 36.78) in epithelial cases (p<0.001). Subtype was the only factor found to affect overall survival.
  • Disease stage was not a significant factor for disease-free survival (p=0.736) or overall survival (p=0.653). Comorbidity was also not a significant factor.
  • Recurrence developed in 41 of 53 patients (77.4%), and follow-up ended because of death in 33 (62.3%)
  • The overall complication rate within one month after surgery was 71.7%. At least one high blood sugar reading occurred in 49 patients (92.5%).
  • Median hospital stay was seven days, and it increased with age (p=0.015)
• The authors' conclusion: The authors concluded that pleurectomy-decortication combined with hyperthermic intrathoracic chemotherapy is a preferable and tolerable treatment for malignant pleural mesothelioma as long as pre- and postoperative management is appropriate. They said patients with epithelial mesothelioma may benefit more from surgery, and that further well-designed studies are needed.
• Limitations the authors state:
  • Single-center, retrospective design
  • The center's location in western Türkiye restricts admission from regions where the disease is more common, which affects the epidemiological data
  • There was no control group, so survival was compared only with published studies

Topics

Medical terms in this study, explained in our Lexicon: Pleurectomy/Decortication (P/D), Chemotherapy, Mesothelioma, Overall Survival, Intrathoracic, Pleural Mesothelioma, Disease-Free Survival, Median Overall Survival.

Related studies

• Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine, prophylactic radiotherapy, and systemic chemotherapy in patients with malignant pleural mesothelioma: a 10-year experience — L. Lang-Lazdunski, A. Bille, et al. (2015)
• Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine followed by adjuvant chemotherapy in patients with malignant pleural mesothelioma — L. Lang-Lazdunski, A. Bille, et al. (2011)
• Local and systemic exposure of cisplatin during hyperthermic intrathoracic chemotherapy perfusion after pleurectomy and decortication for treatment of pleural malignancies — M. Ried, T. Potzger, et al. (2013)
• Pharmacokinetics of Hyperthermic Intrathoracic Chemotherapy following Pleurectomy and Decortication — P.H. Sugarbaker, O.A. Stuart, et al. (2012)
• Comparison of video-assisted pleurectomy/decortication surgery plus hyperthermic intrathoracic chemotherapy with VATS talc pleurodesis for the treatment of malignant pleural mesothelioma: A pilot study — M. Migliore, M. Fiore, et al. (2023)
• Pleurectomy/decortication and hyperthermic intrapleural chemotherapy for malignant pleural mesothelioma: initial experience — M. Migliore, D. Calvo, et al. (2015)

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