A seven-year disease-free survivor of malignant pleural mesothelioma treated with hyperthermia and chemotherapy: a case report

Our plain-English summary of A seven-year disease-free survivor of malignant pleural mesothelioma treated with hyperthermia and chemotherapy: a case report, by N. Okonogi, T. Ebara, H. Ishikawa, et al (Journal of Medical Case Reports, 2012).

The study

• Authors: N. Okonogi, T. Ebara, H. Ishikawa, D. Yoshida, M. Ueno, T. Maeno, T. Suga, T. Nakano
• Journal: Journal of Medical Case Reports
• Published: 2012;6:427
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Malignant pleural mesothelioma was once a rare finding but its incidence is increasing worldwide, most likely because of widespread exposure to asbestos. Although complete surgical resection is considered the only curative treatment, the results of surgery have shown a median survival time of only one year. In inoperable cases, chemotherapy, radiotherapy, and a combination of both have been considered as palliative therapy. Therefore, outcomes for inoperable cases have been poor. Here, we report the case of a long-term survivor treated with hyperthermia and chemotherapy.

Case Presentation: A 61-year-old Japanese man with a performance status of 1 due to chest pain was referred to our hospital. He had a history of asbestos exposure for approximately five years. A computed tomography scan showed diffuse extensive right pleural thickening with small nodular lesions, and video-assisted thoracoscopy revealed tumor invasion of the ipsilateral chest wall muscles. The histopathologic findings were consistent with a diagnosis of malignant pleural mesothelioma (sarcomatoid type). The tumor was diagnosed as being stage cT3N0M0. Our patient refused any invasive therapies including surgery and radiotherapy, and was therefore treated with hyperthermia and systemic chemotherapy with agents such as cisplatin and irinotecan. He underwent three hyperthermia sessions and a single course of chemotherapy without any severe complications. One month after treatment, a follow-up computed tomography scan showed no definitive abnormality in the thoracic space. Our patient has subsequently survived without any evident disease for more than seven years.

Conclusions: The combination of hyperthermia and chemotherapy may be a novel and safe therapeutic option for malignant pleural mesothelioma, and can be considered for patients ineligible for radical treatment. Further clinical studies of the combination of hyperthermia and chemotherapy are needed to confirm the effects of this treatment on malignant pleural mesothelioma.

In plain English

This case report described one patient, a 61-year-old Japanese man with malignant pleural mesothelioma of the sarcomatoid type, stage III (T3N0M0). He had a history of asbestos exposure for approximately five years and a smoking history of 40 pack-years. The article did not name the asbestos fiber type or his job. The authors stated he was eligible for surgery but refused invasive therapies, including surgery and radiotherapy. He received one course of cisplatin and irinotecan chemotherapy together with three weekly hyperthermia sessions, in which a radiofrequency device heated his chest for about 60 minutes. There were no severe complications. A month after the first cycle, a CT scan showed the pleural thickening had disappeared. CT and PET scans six years after treatment showed no evidence of recurrence or spread, and he had been disease free for more than seven years. The authors concluded that hyperthermia with chemotherapy may be a novel and safe option for patients ineligible for radical treatment, and that further clinical studies are needed. As a report on one patient, it does not show how often this works.

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 (single patient)
• Who was studied: One 61-year-old Japanese man treated at Gunma University, Japan, with right-sided malignant pleural mesothelioma (sarcomatoid type), stage T3N0M0 stage III
• Exposure: History of asbestos exposure for approximately five years (fiber type and occupation not stated). He also had a smoking history of 40 pack-years.
• Main results:
  • The patient's tumor was diagnosed as T3N0M0 stage III malignant pleural mesothelioma, sarcomatoid type.
  • The patient was eligible for surgery but refused invasive therapies and was treated with chemotherapy (cisplatin 60 mg per square meter on day one, irinotecan 60 mg per square meter on days one, eight and 15) plus hyperthermia.
  • A month after the first treatment cycle, a CT scan of the patient showed the pleural thickening had disappeared.
  • The patient received three hyperthermia sessions and one course of chemotherapy, with no severe complications.
  • CT and PET scans performed six years after treatment showed no evidence of recurrence or metastasis in the patient.
  • The patient had been disease free for more than seven years without any complications.
• The authors' conclusion: The authors concluded that combining hyperthermia and chemotherapy may be a novel and safe therapeutic option for malignant pleural mesothelioma in patients ineligible for radical treatment, and that further clinical studies are required to confirm its effects.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Chemotherapy, Surgical Resection, Median Overall Survival, Palliative Care, Performance Status, Asbestos Exposure, Pleural Thickening.

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• Free radical activity of natural and heat treated amphibole asbestos — C. Otero Areán, F. Barceló, et al. (2001)
• Long progression-free survival by pemetrexed continuation maintenance therapy following cisplatin-based chemotherapy in malignant pleural mesothelioma — T. Takeda, H. Itano, et al. (2014)
• Quality of life of patients with end-stage peritoneal metastasis treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) — K. Odendahl, W. Solass, et al. (2015)
• Phase 2 study of sorafenib in malignant mesothelioma previously treated with platinum-containing chemotherapy — S. Papa, S. Popat, et al. (2013)

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