En bloc resection of the recurrent pleural mesothelioma and reconstruction of the chest wall after immunotherapy: A case report

Our plain-English summary of En bloc resection of the recurrent pleural mesothelioma and reconstruction of the chest wall after immunotherapy: A case report, by C. Qin, Q. Xia, Z.J. Chen, et al (Thoracic Cancer, 2023).

The study

• Authors: C. Qin, Q. Xia, Z.J. Chen, Q. Zhou, X. Zheng
• Journal: Thoracic Cancer
• Published: 2023;14(30):3063-3066
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is associated with previous asbestos exposure, while more clinical insights into this disease have come from other case studies. Maximal cytoreduction is critical in disease control and might help to improve the prognosis. Here, a 41-year-old female presented with a 6-month history of a mass detected in the chest wall following resection of a right pleural mesothelioma 2 years previously. A fluorodeoxyglucose positron emission tomography/computed tomography scan showed a right chest wall mass with a blurred boundary 8.9 cm × 3.7 cm in size. The patient had received one cycle of bevacizumab, carboplatin, and pemetrexed, and two cycles of nivolumab, ipilimumab, and gemcitabine 5 months before admission. We subsequently resected the tumor, the involved diaphragm, and the fifth and sixth ribs, and titanium mesh and continuous suture were used to close the thoracic cage. The fixed paraffin-embedded tissues showed epithelioid pleural mesothelioma. The patient received nivolumab and ipilimumab postoperatively, and no recurrence was detected 16 months after surgery. En bloc resection with reconstructive surgery effectively removed the locally advanced malignancy and restored the biological function of the thorax with a favorable prognosis. Neoadjuvant immunotherapy might therefore be conducive to radical resection and perioperative immunotherapy might improve the prognosis.

© 2023 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

In plain English

This case report from West China Hospital, Sichuan University, described one 41-year-old woman with recurrent epithelioid pleural mesothelioma. The article did not say whether she had been exposed to asbestos. Two years earlier she had a right open pleurectomy followed by chemotherapy. Six months before admission, a right chest wall mass measuring 8.9 cm by 3.7 cm was found. She received one cycle of bevacizumab, carboplatin and pemetrexed, then two cycles of nivolumab, ipilimumab and gemcitabine, during which she developed skin peeling and red plaques. The mass stayed about the same size (8.5 cm by 4.0 cm). Surgeons removed the tumor together with the involved diaphragm and the fifth and sixth ribs, and rebuilt the chest wall with titanium mesh. Afterwards she again received nivolumab and ipilimumab. No recurrence was detected 16 months after surgery, and no adverse event was reported during follow-up. The authors concluded that this surgery could remove locally advanced disease and restore chest function, and that immunotherapy before and around surgery might help.

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 (one patient)
• Who was studied: One 41-year-old woman with a recurrent right chest wall mass after earlier resection of a right pleural mesothelioma, treated at West China Hospital, Sichuan University, Chengdu, People's Republic of China
• Exposure: The article does not report any asbestos exposure for this patient. Its subject is treatment: chemotherapy, dual immunotherapy (nivolumab and ipilimumab), en bloc surgical resection and chest wall reconstruction.
• Main results:
  • Two years before admission, pleural masses were removed and found to be epithelioid mesothelioma. She then had a right open pleurectomy and four cycles of cisplatin and pemetrexed.
  • One year before admission, a 7 mm nodule in the right lung led to two more cycles of chemotherapy.
  • Six months before admission, a right chest wall mass of 8.9 cm by 3.7 cm with a blurred boundary was seen on FDG-PET/CT.
  • She then received one cycle of bevacizumab, carboplatin and pemetrexed, and two cycles of nivolumab 360 mg, ipilimumab 1 mg/kg and gemcitabine 1000 mg/m2, 5 months before admission.
  • During dual immunotherapy she had skin desquamation (peeling) and red plaques on the arms, legs and around the waist.
  • After this treatment the mass was comparable in size to before (8.5 cm by 4.0 cm).
  • Surgeons resected the tumor, the involved diaphragm and the fifth and sixth ribs, and reconstructed the thoracic cage with titanium mesh and continuous suture.
  • Tissue after surgery showed epithelioid pleural mesothelioma, with positive staining for calretinin, D2-40 and other markers.
  • After surgery she received nivolumab and ipilimumab. No recurrence was detected 16 months after surgery, and no adverse event was reported during follow-up.
• The authors' conclusion: The authors concluded that en bloc resection with reconstructive surgery could remove locally advanced malignancy encroaching on the chest wall and restore the function of the thorax. They also concluded that neoadjuvant immunotherapy might help make radical resection possible and that perioperative immunotherapy might improve prognosis.

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, Immunotherapy, Asbestos Exposure, Cytoreductive Surgery, Prognosis, Bevacizumab, Carboplatin, Pemetrexed (Alimta).

Related studies

• Long-term results of chest wall reconstruction with DualMesh — T. Nagayasu, N. Yamasaki, et al. (2010)
• Initial experience with the use of biological implants for soft tissue and chest wall reconstruction in thoracic surgery — A. Barua, J.A. Catton, et al. (2012)
• Clinical indications and results after chest wall resection for recurrent mesothelioma — B.M. Burt, S.O. Ali, et al. (2013)
• Well-differentiated papillary mesothelioma with invasion to the chest wall — I. Torii, M. Hashimoto, et al. (2010)
• Tumor extension along chest wall tract after diagnostic intervention in malignant pleural mesothelioma — F. Chen, A. Yoshizawa, et al. (2011)
• Morbidity of the abdominal wall resection and reconstruction after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) — M.F. Nunez, A. Sardi, et al. (2015)

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