Cytoreductive surgery and post-operative heated pleural chemotherapy for the management of pleural surface malignancy

Our plain-English summary of Cytoreductive surgery and post-operative heated pleural chemotherapy for the management of pleural surface malignancy, by K. Kodama, M. Higashiyama, J. Okami, et al (International Journal of Hyperthermia, 2013).

The study

• Authors: K. Kodama, M. Higashiyama, J. Okami, T. Tokunaga, A. Fujiwara, F. Imamura, T. Nakayama
• Journal: International Journal of Hyperthermia
• Published: 2013;29(7):653-62
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: We retrospectively analysed the long-term outcomes of cytoreductive surgery and post-operative heated pleural chemotherapy (HPC) for thoracic malignancies with pleural spread.

Materials And Methods: Between 1987 and 2010, 160 patients were enrolled. There were 101 patients with non-small cell lung cancer (NSCLC), 25 with malignant pleural mesothelioma (MPM), 12 with thymoma, and 22 with tumours metastatic to the lung and pleura. Immediately after intra-thoracic administration of cisplatin or carboplatin, hyperthermia was performed by using an 8.00 MHz radiofrequency capacitive heating device for 1 to 4 courses in each patient.

Results: There was no systemic toxicity or treatment-related mortality. Five-year overall survival rates were 37.4% in NSCLC, 15.9% in MPM, 91.7% in thymoma, and 25.8% in metastatic lung tumour. Five-year local relapse-free survival (RFS) rates were 55.2% in NSCLC, 24.4% in MPM, 64.8% in thymoma, and 27.2% in tumours metastatic to the lung and pleura. When 101 NSCLCs were categorised into pleural lavage cytology positive (grade 1: n = 37), limited extent of carcinomatous pleuritis (grade 2: n = 21), and extensive carcinomatous pleuritis (grade 3: n = 43), 5-year overall survival rates were 62.5%, 49.2%, and 13.6%, respectively. The local RFS was significantly better in group 1/2 than in group 3.

Conclusions: Although our study has some of the usual weaknesses of a single institution retrospective study, cytoreductive surgery and HPC are feasible and safe. It is suggested that HPC may have a potential role for local control as adjuvant treatment for cytoreductive surgery in patients with minor pleural spread.

In plain English

This single-institution retrospective study from Osaka, Japan, reviewed 160 patients treated between 1987 and 2010 for cancer on the pleura (the lining around the lungs) or, in some, cancer cells found only in chest-cavity washings. Of these, 101 had non-small cell lung cancer, 25 malignant pleural mesothelioma, 12 thymoma and 22 tumours spread from other organs. After surgery to remove as much tumour as possible, cisplatin or carboplatin was put into the chest, which was then heated with radiofrequency. The article does not discuss asbestos. The authors reported no systemic toxicity and no treatment-related deaths. The most common side effect, in 87 of 164 treated patients (53.0%), was grade 1 (mildest) skin pain under the electrode. In the mesothelioma group, overall survival was 21.3% at 3 years, 15.9% at 5 years and 8.0% at 10 years. In lung cancer patients, 5-year survival was 62.5% with cancer cells only in washings, 49.2% with limited pleural spread and 13.6% with extensive pleural spread. The authors concluded the treatment was feasible and safe, but said the findings should be replicated in independent prospective 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-institution retrospective study of treatment outcomes (surgery followed by heated pleural chemotherapy)
• Who was studied: 160 patients with pleural surface malignancy, treated at Osaka Medical Centre, Japan, between 1987 and 2010. Some had cancer cells detected only on pleural lavage cytology: 37 of the NSCLC patients and 5 of the metastatic-tumour patients. By diagnosis, there were 101 with non-small cell lung cancer (NSCLC), 25 with malignant pleural mesothelioma (MPM: 9 epithelial type, 16 non-epithelial type), 12 with thymoma, and 22 with tumours metastatic to the lung and pleura from other organs. 92 were male and 68 female.
• Exposure: No asbestos exposure is reported. The study examined a treatment: cytoreductive surgery, then cisplatin (50 to 100 mg) or carboplatin (450 mg) put into the chest cavity, then 1 hour of heating with an 8 MHz radiofrequency capacitive device. Patients received one to four courses.
• Main results:
  • No systemic toxicity and no treatment-related deaths were reported.
  • 25 MPM patients: overall survival rates were 21.3% at 3 years, 15.9% at 5 years and 8.0% at 10 years.
  • 25 MPM patients: local relapse-free survival rates were 45.7% at 3 years, 24.4% at 5 years and 24.4% at 7 years.
  • MPM patients: those with major resection plus heated chemotherapy had better local relapse-free survival (53.1% and 35.4% at 3 and 5 years) than those with minor resection (33.9% and 0% at 3 and 4 years; p = 0.0053). There was no significant difference in overall survival between the two groups.
  • 101 NSCLC patients, 3-, 5- and 10-year overall survival by grade:
• Grade 1 (pleural lavage cytology positive only, n = 37): 78.0%, 62.5% and 30.6%.
• Grade 2 (limited extent of carcinomatous pleuritis, n = 21): 70.2%, 49.2% and 20.5%.
• Grade 3 (extensive carcinomatous pleuritis, n = 43): 40.5%, 13.6% and 0%.
  • NSCLC patients: local relapse-free survival was significantly better in grades 1 and 2 combined (n = 58; 68%, 68% and 58.3% at 3, 5 and 10 years) than in grade 3 (p = 0.02).
  • 164 patients assessed for adverse events: none had grade 2 or higher toxicity. The most common was grade 1 skin pain beneath the electrode, in 87 patients (53.0%).
• The authors' conclusion: The authors concluded that heated pleural chemotherapy was feasible and safe, even combined with major resection such as extrapleural pneumonectomy. They suggested it may offer local control for patients with free tumour cells in the chest cavity and micrometastases on the pleural surface.
• Limitations the authors state:
  • The authors state the study has the usual weaknesses of a single-institution retrospective study.
  • The authors state the findings need to be replicated in independent prospective studies.

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, Chemotherapy, Non-Small Cell Lung Cancer, Pleural Mesothelioma, Pleura, Cisplatin, Carboplatin, Overall Survival.

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• Repeat cytoreductive surgery and heated intraperitoneal chemotherapy may offer survival benefit for intraperitoneal mesothelioma: a single institution experience — J. Wong, A.L. Koch, et al. (2014)
• Multicystic mesothelioma: Operative and long-term outcomes with cytoreductive surgery and hyperthermic intra peritoneal chemotherapy — E. Nizri, D. Baratti, et al. (2018)
• Evaluation of the cost-effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (peritonectomy) at the St George Hospital peritoneal surface malignancy program — T.C. Chua, S. Martin, et al. (2010)
• Anesthetic management and renal function in pediatric patients undergoing cytoreductive surgery with continuous hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin — P. Owusu-Agyemang, R. Arunkumar, et al. (2012)
• Repeat Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancy and Peritoneal Carcinomatosis — J.F. Wong, G.H. Tan, et al. (2015)

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