Conversion surgery for locally advanced malignant pleural mesothelioma

Our plain-English summary of Conversion surgery for locally advanced malignant pleural mesothelioma, by Y. Terada, M. Isaka, H. Murakami, et al (General Thoracic and Cardiovascular Surgery, 2020).

The study

• Authors: Y. Terada, M. Isaka, H. Murakami, T. Kawata, H. Konno, H. Kojima, T. Mizuno, Y. Ohde
• Journal: General Thoracic and Cardiovascular Surgery
• Published: 2020;68(12):1547-1550
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Two women in their sixties were diagnosed with inoperable locally advanced epithelioid malignant pleural mesothelioma, c-stage IIIB. Post-chemotherapy, the tumors down-staged to yc-stage IA, and pleurectomy/decortication were performed. The pathological diagnoses were p-stages II and IA. One patient had tumor recurrence 6 months after surgery; she is currently undergoing fourth-line chemotherapy and is alive 30 months postoperatively. The second patient had tumor recurrence 4 months after surgery and died 2 months later. Conversion surgery for advanced malignant mesothelioma does not improve progression-free survival but might have a chance to extend overall survival in selected patients without deteriorating performance status.

In plain English

This case report from Shizuoka Cancer Center, Japan, described two women aged 60 and 67. Both had epithelioid malignant pleural mesothelioma judged inoperable at diagnosis (clinical stage IIIB). The 67-year-old woman had a history of asbestos exposure in her twenties. No exposure is described for the other. Both received six cycles of pemetrexed and cisplatin chemotherapy. After chemotherapy, both tumors were re-staged as stage IA. For the second woman this was based on scans and a lymph-node biopsy that found no cancer. Both women then had pleurectomy/decortication, a lung-sparing operation. Examination of the removed tissue found living tumor cells in the pleura of both women. The first woman's cancer returned six months after surgery and she received further treatment. Thirty months after surgery she was reported to be in good health and working. The second woman's cancer spread to the abdominal lining four months after surgery, and she died six months after surgery. The authors concluded that this "conversion surgery" may not improve progression-free survival but can be performed with acceptable complications. They said further investigation is needed on whether it improves overall survival.

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 (two patients)
• Who was studied: Two women, aged 60 and 67, with epithelioid malignant pleural mesothelioma initially judged inoperable (clinical stage IIIB), treated at Shizuoka Cancer Center, Japan
• Exposure: The second patient (Case B) had a history of asbestos exposure in her twenties. No fiber type or job is given, and no exposure is described for the first patient (Case A). The treatments studied were pemetrexed and cisplatin chemotherapy followed by pleurectomy/decortication.
• Main results:
  • After six cycles of chemotherapy, both tumors were down-staged from clinical stage IIIB to stage IA. For Case B, this followed shrinkage on imaging and a mediastinal lymph node biopsy that was negative for metastasis.
  • In both patients, tissue examination after surgery found viable tumor cells in the parietal pleura, even though imaging had shown a strong response to chemotherapy.
  • In Case A, macroscopic complete resection could not be achieved. Lymph node spread was found, and the pathological stage was II. Case B had macroscopic complete resection, with a pathological stage of IA.
  • In Case A, the tumor recurred 6 months after surgery. She then received second-, third- (nivolumab) and fourth-line treatment.
  • Case A was reported to be in good health and working 30 months after surgery.
  • In Case B, peritoneal dissemination was found 4 months after surgery, and she died 6 months after surgery.
  • Operation duration was 658 min for Case A and 647 min for Case B. Blood loss was 2249 ml for Case A and 2455 ml for Case B. Hospital stays were 23 days for Case A and 16 days for Case B. The authors described the postoperative courses as uneventful.
• The authors' conclusion: The authors concluded that conversion surgery for initially inoperable locally advanced malignant pleural mesothelioma after chemotherapy may not improve progression-free survival but can be performed with acceptable complications. They said further investigation is needed to decide whether it improves overall survival.

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, Epithelioid, Chemotherapy, Stage IA, Pleurectomy/Decortication (P/D), Malignant Mesothelioma, Progression-Free Survival, Overall Survival.

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