Cytoreductive surgery and hyperthermic intrapleural chemotherapy for malignant pleural diseases: preliminary experience

Our plain-English summary of Cytoreductive surgery and hyperthermic intrapleural chemotherapy for malignant pleural diseases: preliminary experience, by M. Migliore, D. Calvo, A. Criscione, et al (Future Oncology, 2015).

The study

• Authors: M. Migliore, D. Calvo, A. Criscione, C. Viola, G. Privitera, C. Spatola, H.S. Parra, S. Palmucci, N. Ciancio, R. Caltabiano, G. Di Maria
• Journal: Future Oncology
• Published: 2015;11(2 Suppl):47-52
• Cited by: 25 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Cytoreductive surgery and hyperthermic-intraoperative-intrapleural-chemotherapy (HITHOC) is a known approach for malignant pleural diseases (MPD). This study was started to clarify the role of cytoreductive surgery and HITHOC in MPD. Criteria of inclusion were early-stage disease in malignant pleural mesothelioma (MPM), young age, good condition and selected stage-M1a lung cancer. Six patients with MPM and two patients with lung cancer were enrolled. After surgical debulking, intrapleural cisplatin was administered for 60 min at 42.5°C. Wedge, rib resection and repaired diaphragm were added in three, one and one patient, respectively. Morbidity, toxicity and mortality was nil. Hospital stay was 8 days. Mean survival is 13.6 months. This experience confirms that cytoreductive surgery and HITHOC is a good option in the treatment of MPD. A randomized controlled trial is necessary.

In plain English

This was a small prospective study from the University of Catania, Italy, begun in October 2011. Eight patients with cancer of the pleura (the lining around the lungs) were treated. Six had malignant pleural mesothelioma (five epithelial, one biphasic), and two had lung adenocarcinoma that had spread to the pleura. Five of the six mesothelioma patients had previous asbestos exposure. Its type and amount were not described. Surgeons removed as much visible tumor as possible, then circulated the chemotherapy drug cisplatin, heated to 42.5°C, inside the chest for 60 minutes. No complications or toxicity were recorded during surgery; mean hospital stay was 8 days. Among the mesothelioma patients, no one died within 30 days. Mean survival was 13.3 months, and five were alive at the time of writing. One patient's creatinine level rose, and two needed anti-nausea drugs. The authors concluded this approach could represent a treatment choice, but that a randomized trial is needed. They noted the sample was so small that significant relationships would be difficult to detect. Some figures differ between the text and the table.

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: prospective case series (single-center surgical experience, no comparison group)
• Who was studied: Eight patients (six men, two women; mean age 63.7 years, range 54 to 77) treated at A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Italy, from October 2011. Six had malignant pleural mesothelioma (five epithelial, one biphasic) and two had lung adenocarcinoma with pleural metastasis.
• Exposure: The study evaluated a treatment: cytoreductive surgery followed by intrapleural cisplatin (120 mg/m2 for 60 minutes at 42.5°C). Regarding asbestos, five of the six mesothelioma patients had previous asbestos exposure. Fiber type, source and amount are not reported.
• Main results:
  • Across all eight patients, no intraoperative complications or toxicity were recorded.
  • Across all eight patients, mean hospital stay was 8 days (range 6 to 10).
  • In the six mesothelioma patients, 30-day mortality was 0 and the text reported no complications. One patient needed two units of blood transfusion, and two patients were transferred to ICU for 24 hours.
  • In one mesothelioma patient with chronic renal failure, the creatinine level rose on day 2. Two mesothelioma patients had nausea and vomiting that required antiemetic drugs.
  • In the six mesothelioma patients, mean survival was 13.3 months (6 to 21 months), and five were alive at the time of writing.
  • In five of six mesothelioma patients, pleural fluid cytology after the heated chemotherapy (sample 3) was negative for neoplastic cells compared with the sample taken when the chest was opened (sample 1).
  • Of the two lung adenocarcinoma patients, the first (a woman) was alive at 16 months after surgery, with a disease-free interval of 13 months. The second (a man) was alive at 6 months.
• The authors' conclusion: The authors concluded that cytoreductive surgery (pleurectomy/decortication) with heated intrathoracic chemotherapy could represent a treatment choice for malignant pleural mesothelioma and for selected patients with lung cancer and pleural metastasis. They added that a randomized clinical trial is needed.
• Limitations the authors state:
  • The authors stated that the sample size was too small, so it will be difficult to find significant relationships in the data.

Topics

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

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, Chemotherapy, Pleural Mesothelioma, Lung Cancer, Cisplatin, Diaphragm.

Related studies

• Pleurectomy/decortication and hyperthermic intrapleural chemotherapy for malignant pleural mesothelioma: initial experience — M. Migliore, D. Calvo, et al. (2015)
• Treating peritoneal mesothelioma with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. A case series and review of the literature — K. Stamou, D. Tsamis, et al. (2015)
• Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience — A. Arjona-Sanchez, S. Rufian-Peña, et al. (2018)
• Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience — M. Ried, T. Potzger, et al. (2013)
• Multicystic mesothelioma: Operative and long-term outcomes with cytoreductive surgery and hyperthermic intra peritoneal chemotherapy — E. Nizri, D. Baratti, et al. (2018)
• Abdominal Wall Morbidity Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy — F. Struller, I. Koenigsrainer, et al. (2017)

Browse more research in Future Oncology, or return to medical research.