Cold-plasma coagulation in the treatment of malignant pleural mesothelioma: results of a combined approach

Our plain-English summary of Cold-plasma coagulation in the treatment of malignant pleural mesothelioma: results of a combined approach, by M. Hoffmann, H.P. Bruch, P. Kujath, et al (Interactive Cardiovascular and Thoracic Surgery, 2010).

The study

• Authors: M. Hoffmann, H.P. Bruch, P. Kujath, S. Limmer
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2010;10(4):502-5
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma is on a continuous rise throughout the Western countries. It is associated with asbestos fibre exposition in the past. Surgical approaches include extrapleural pneumonectomy and pleurectomy/decortication (P/D). We investigated the feasability of the implementation of cold-plasma coagulation (CPC) on the pleura, pericardium and diaphragm into an established therapeutic algorithm consisting of P/D and hyperthermic intrathoracal chemoperfusion (HITHOC) therapy. The underlying rationale was the prevention of cardiotoxic effects during HITHOC as well as accidental translocation of malignant cells to the abdomen. CPC was done as part of a multimodal therapy in stage III mesothelioma patients. Histologic examinations of pleural excisates after CPC were done. The patients were followed up in three-month intervals. Neither parenchymal fistulas, nor cardiotoxic effects were observed. The histologic examination of the pleural excisates showed complete predictable necrosis. Moreover, until now (median time after operation 1 year) no relapse of the disease was observed. CPC proved to be a safe technique when used on the pleura, pericardium and diaphragm. We consider our trial as a pilot-study. To evaluate potential survival benefits using this technique larger trials are mandatory.

In plain English

This report from a surgical clinic in Luebeck, Germany, described the first eight patients treated with a new step added to an existing operation for malignant pleural mesothelioma. All eight were men with stage III disease who had been exposed to asbestos fibers several times. The article did not name the fiber types. Surgeons removed the pleura (pleurectomy and decortication) and used cold-plasma coagulation, a technique meant to destroy only a thin surface layer of tissue, on the diaphragm and pericardium. They then bathed the chest with heated chemotherapy containing cisplatin and doxorubicin. All patients later received pemetrexed. The data were reviewed retrospectively, without statistical analysis. No patient died within 90 days of surgery. Two patients had bleeding, and one of them needed a second operation. One patient died in month ten from cardio-pulmonary failure. Tissue samples showed no living tumor cells after coagulation. Follow-up lasted at most 12 months, and in that time no disease progression was found in surviving patients. The authors considered their results partial proof of concept and called for a larger multi-center comparison 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 case series of the first eight patients given a new combined surgical approach (described as a work in progress report and, in the abstract, a pilot study); no statistical analysis
• Who was studied: Eight male patients with stage III malignant pleural mesothelioma after asbestos exposure, treated at the University Clinic Schleswig-Holstein, Campus Luebeck, Germany; dates of treatment not given
• Exposure: Asbestos exposure: patients had multiple exposures to asbestos fibers, with fiber types not specified. The treatment studied was pleurectomy/decortication with cold-plasma coagulation of the diaphragm and pericardium, followed by heated intrathoracic chemoperfusion with cisplatin and doxorubicin, then pemetrexed chemotherapy and radiation to the surgical sites.
• Main results:
  • No perioperative or 90-day postoperative deaths among the eight patients
  • One patient had minor bleeding treated with three units of red blood cells
  • The patient taking aspirin before surgery had major bleeding that required a second operation
  • One patient had a temporary rise in a kidney function marker, which returned to baseline by day 14 after surgery
  • One patient died in postoperative month ten from cardio-pulmonary failure
  • With a longest follow-up of 12 months, no pleural effusions or disease progression were detected in surviving patients
  • Tissue samples taken after cold-plasma coagulation showed no living tumor cells
  • Average hospital stay was 15 days (range 12 to 23 days)
  • In telephone interviews, all patients said their quality of life had improved
• The authors' conclusion: The authors concluded that the technique appeared safe, without major adverse events, and considered the results partial proof of concept. They called for a multi-center trial comparing the multimodal approach with palliative chemotherapy alone.
• Limitations the authors state:
  • Statistical analysis was not done because there were few patients and follow-up was short
  • The approach was not compared with another treatment; the authors state that a direct comparison is needed
  • The authors note that using the technique without prior clinical experience might be ineffective and could risk disease progression or early relapse

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D), Pleura, Pericardium, Diaphragm, Translocation, Multimodal Therapy.

Related studies

• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Is less also better? A single-institution experience on treatment of early stage Malignant Pleural Mesothelioma — P. Bertoglio, M.C. Ambrogi, et al. (2017)
• Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for malignant peritoneal mesothelioma: mitomycin versus cisplatin — A.U. Blackham, P. Shen, et al. (2010)
• Multimodality treatment of malignant pleural mesothelioma with or without immunotherapy: does it change anything? — M. Lucchi, A. Picchi, et al. (2010)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)

Browse more research in Interactive Cardiovascular and Thoracic Surgery, or return to medical research.