Effect of intraoperative hyperthermic intrathoracic chemotherapy after pleurectomy decortication for treatment of malignant pleural mesothelioma: a comparative study

Our plain-English summary of Effect of intraoperative hyperthermic intrathoracic chemotherapy after pleurectomy decortication for treatment of malignant pleural mesothelioma: a comparative study, by H.H. Elsayed, H.Y. Sharkawy, M.A. Ahmed, et al (Updates in Surgery, 2024).

The study

• Authors: H.H. Elsayed, H.Y. Sharkawy, M.A. Ahmed, M. Abdel-Gayed, M. Eldewer
• Journal: Updates in Surgery
• Published: 2024;76(8):2893-2901
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive malignancy with few long-term survivors. Despite the dismal prognosis, hyperthermic intrathoracic chemoperfusion (HITOC) was shown to improve survival in a selective group of patients. We analyzed the influence of HITOC following pleurectomy and decortication on postoperative morbidity and overall survival for patients suffering from localized mesothelioma. From March 2017 until August 2023, 55 patients with localized pleural mesothelioma underwent pleurectomy and decortication. Thirty patients performed only surgery while 25 consecutive patients had surgery followed by HITOC with cisplatin (125 mg/m2) infused for 70 min at a temp of 40-43 °C. We analyzed postoperative morbidity, HITOC-related complications, and the influence of HITOC on survival. The trial was registered on 19/08/2022 as NCT05508555. The HITOC group had a mean age of 53.1 ± 8.2 years while the surgery group (non-HITOC) had a mean age of 52.1 ± 8.6 years. The HITOC group had 17 (68%) men, whereas the surgery group included 18 (60%) males. The 30-day mortality in the HITOC group was 0% vs 1 case (3.3%) in the surgery group. HITOC-related transient complications occurred in 4/25 (16%) of the HITOC group (atrial fibrillation, renal impairment and transient hypotension). Progression-free survival in the HITOC group was 8 months (95% CI 4.3-11.6) vs 6 months (95% CI 2.5-9.9) in the surgery-only group (p = 0.79). The overall survival time in the HITOC group was 28 months (95% CI 21.5-34.5) vs 22 months (95% CI 17.5-26.5) in the surgery-only group (p = 0.75). Risk factors analysis for recurrence in the HITOC group confirmed a significant role for early stages (p = 0.03). HITOC following pleurectomy and decortication is a safe therapeutic option that may improve survival for selected patients with localized epithelial pleural mesothelioma. Patients with earlier-stage mesothelioma are more likely to benefit from radical surgery and HITOC.

© 2024. The Author(s).

In plain English

This study from Cairo, Egypt, compared patients with localized malignant pleural mesothelioma who had pleurectomy and decortication, an operation that removes the lining around the lung. Twenty-five patients treated from October 2020 to August 2023 also received heated cisplatin chemotherapy inside the chest during the operation (HITOC). They were compared with 30 earlier patients (March 2017 to September 2020) who had the same surgery without HITOC. Of these, 27 had chemotherapy beforehand. Patients were not randomized. No HITOC patient died within 30 days, compared with 1 patient without HITOC (3.3%). Complications linked to HITOC occurred in 4 of 25 patients (16%). Median progression-free survival was 8 months (95% confidence interval 4.3 to 11.6) with HITOC and 6 months (2.5 to 9.9) without it. Median overall survival was 28 months (21.5 to 34.5) versus 22 months (17.5 to 26.5). Neither difference was statistically significant. Hospital stay was shorter in the HITOC group. Within that group, disease stage was the only factor tested that was significantly linked to recurrence. The authors concluded that HITOC after this surgery is safe and may improve survival in selected patients with localized epithelial pleural mesothelioma. They called for larger 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: Non-randomized comparative study: a prospectively studied HITOC group compared with a historical (retrospective) group that had surgery without HITOC
• Who was studied: 55 patients with localized malignant pleural mesothelioma (stage I, II and low-volume stage III; epithelioid and some biphasic subtypes) treated at a tertiary thoracic surgery centre. The HITOC group had 25 patients (October 2020 to August 2023). The comparison group, which the article calls the surgery or surgery-only group, had 30 patients (March 2017 to September 2020). In that comparison group, 27 received neoadjuvant chemotherapy and 17 received postoperative pemetrexed.
• Exposure: The study examined a treatment, not asbestos exposure. All patients had pleurectomy and decortication (simple or extended). The HITOC group also received hyperthermic intrathoracic chemotherapy: cisplatin 125 mg/m2 infused for 70 minutes at 40 to 43 degrees Celsius. Systemic chemotherapy before and after surgery was given in both groups. The article does not report the patients' asbestos exposure.
• Main results:
  • 30-day mortality was 0% in the HITOC group and 1 case (3.3%) in the group without HITOC (P = 0.5)
  • HITOC-related complications occurred in 4 of 25 HITOC patients (16%). Each of the following occurred in one case (4%): atrial fibrillation, mild grade I nephropathy, transient hypotension during infusion, and left arm weakness with lid ptosis that resolved after 5 days.
  • Median progression-free survival was 8 months (95% CI 4.3 to 11.6) in the HITOC group versus 6 months (95% CI 2.5 to 9.9) in the group without HITOC. The difference was not statistically significant (P = 0.79).
  • Median overall survival was 28 months (95% CI 21.5 to 34.5) in the HITOC group versus 22 months (95% CI 17.5 to 26.5) in the group without HITOC. The difference was not statistically significant (P = 0.75).
  • Mean hospital stay was 7.04 days (SD 3.49) in the HITOC group versus 8.70 days (SD 1.70) in the group without HITOC (P = 0.04)
  • In the group without HITOC, 27 of the 30 patients received neoadjuvant chemotherapy
  • Within the HITOC group, clinical stage was the only factor significantly correlated with recurrence (P = 0.03). No factor was significantly correlated with survival.
• The authors' conclusion: The authors concluded that HITOC following pleurectomy and decortication is a safe therapeutic option that may improve survival for selected patients with localized epithelial pleural mesothelioma. They also concluded that patients with earlier-stage disease are more likely to benefit.
• Limitations the authors state:
  • The authors stated that the better survival seen with HITOC may warrant larger studies to achieve statistical significance

Topics

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

Medical terms in this study, explained in our Lexicon: Intrathoracic, Chemotherapy, Pleural Mesothelioma, Prognosis, Overall Survival, Localized Malignant Mesothelioma, Cisplatin, Progression-Free Survival.

Related studies

• Local and systemic exposure of cisplatin during hyperthermic intrathoracic chemotherapy perfusion after pleurectomy and decortication for treatment of pleural malignancies — M. Ried, T. Potzger, et al. (2013)
• Interim results of pleurectomy/decortication and intraoperative intrapleural hyperthermic cisplatin perfusion for patients with malignant pleural mesothelioma intolerable to extrapleural pneumonectomy — H. Ishibashi, M. Kobayashi, et al. (2015)
• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)
• Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine, prophylactic radiotherapy, and systemic chemotherapy in patients with malignant pleural mesothelioma: a 10-year experience — L. Lang-Lazdunski, A. Bille, et al. (2015)
• Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine followed by adjuvant chemotherapy in patients with malignant pleural mesothelioma — L. Lang-Lazdunski, A. Bille, et al. (2011)
• Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience — M. Ried, T. Potzger, et al. (2013)

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