Feasibility of multimodality treatment, including pleurectomy decortication, in carefully selected patients with sarcomatoid mesothelioma

Our plain-English summary of Feasibility of multimodality treatment, including pleurectomy decortication, in carefully selected patients with sarcomatoid mesothelioma, by M. Lapidot, E. Mazzola, R. Bueno (Translational Lung Cancer Research, 2026).

The study

• Authors: M. Lapidot, E. Mazzola, R. Bueno
• Journal: Translational Lung Cancer Research
• Published: 2026;15(1):11
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pleural mesothelioma (PM) represents an uncommon and exceptionally lethal malignancy. The sarcomatoid subtype constitutes the rarest histological variant, traditionally linked to the worst prognosis, while the advantages of operative intervention remain inadequately established. In this study, we present findings from a cohort of 34 sequential cases with sarcomatoid mesothelioma managed at a specialized high-volume center employing pleurectomy decortication (PD) within a comprehensive therapeutic strategy. We aim to identify patients in this cohort who may benefit from a multimodality approach.

Methods: All patients diagnosed with sarcomatoid mesothelioma between 2007 and 2019 who received PD at our facility were enrolled, and relevant medical, histopathological, and operative data collected. Survival curves generated through Kaplan-Meier methodology alongside log-rank testing enabled comparison of longevity outcomes, while Cox proportional hazards modeling facilitated examination of predictive variables.

Results: The cohort included 31 male subjects (91.2%), 24 procedures performed on the right side (70.6%), with a median patient age of 71.5 years (range, 51-85 years). Preoperative treatment was administered to 8 individuals (24.2%), while 23 participants (67.7%) underwent intraoperative heated chemotherapy (IOHC). Macroscopic complete resection (MCR) was accomplished in 22 cases (64.7%). Mortality at 30 and 90 days post-surgery stood at 2.9% and 14.7%, respectively. The median overall survival for the entire cohort reached 7.4 months, extending to 20.1 months among those with forced expiratory volume in 1 second (FEV1) at or above 80% predicted. In multivariate analysis, preoperative FEV1 ≥80% was associated with prolonged overall survival [P=0.01; hazard ratio (HR) =0.54].

Conclusions: As expected, the median survival for most patients with sarcomatoid histology who undergo surgery is under one year. However, a small subset of patients with FEV1 ≥80% do quite well using the multimodality approach.

© AME Publishing Company.

In plain English

The authors studied 34 consecutive patients with sarcomatoid pleural mesothelioma who had pleurectomy decortication (surgery removing the lining of the lung and chest wall) at Brigham & Women's Hospital from 2007 to 2019. Some had heated chemotherapy during surgery or chemotherapy before or after. Twenty-five (73.5%) had a history of asbestos exposure. All visible tumor was removed in 22 (64.7%). Thirty-day mortality was 2.9% (95% confidence interval 0.0 to 8.5%) and ninety-day mortality 14.7% (1.9 to 25.8%). Median survival after surgery was 7.4 months (6.54 to 14.7) overall. It was 20.1 months (from 7.33 months; no upper limit reported) for the nine patients whose pre-surgery lung function (FEV1) was at least 80% of predicted. Good lung function and chemotherapy after surgery were each independently associated with longer survival. Heated chemotherapy did not appear to affect survival. Patients with complete visible removal survived numerically longer, but the difference was not statistically significant. The authors concluded that most patients derive limited benefit, but a small subset with early T-stage (limited local) disease and preserved lung function may be suitable candidates. They noted the study was retrospective and small.

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: Retrospective review of a prospectively compiled database from a single academic medical center (surgical case series)
• Who was studied: 34 consecutive patients with sarcomatoid pleural mesothelioma (confirmed on postoperative pathology) who underwent pleurectomy decortication at Brigham & Women's Hospital, Boston, January 2007 to December 2019. 31 were male, and the median age was 71.5 years (range 51 to 85).
• Exposure: This is a treatment study, not an exposure study. Treatment was pleurectomy decortication. 23 patients also received intraoperative heated chemotherapy (cisplatin), and some received neoadjuvant or adjuvant chemotherapy. Asbestos exposure history was recorded for 25 of 34 patients (73.5%), including 74.2% of males and 66.6% of females. No fiber types or doses were reported.
• Main results:
  • Macroscopic complete resection (removal of all visible tumor) was achieved in 22 of 34 patients (64.7%).
  • Among all 34 patients, 30-day mortality was 2.9% (95% CI 0.0 to 8.5%) and 90-day mortality was 14.7% (95% CI 1.9 to 25.8%).
  • Median overall survival was 7.4 months (95% CI 6.54 to 14.7 months) for all patients and 9.53 months (95% CI 5.36 to 20.1 months) in the complete-resection group.
  • Among the nine patients with preoperative FEV1 at or above 80%, median survival was 20.1 months (95% CI 7.33 to not available). Table 2 gives 6.85 months for patients with FEV1 below 80% (univariate HR 0.3, 95% CI 0.11 to 0.81, P=0.01).
  • In multivariate analysis of all patients, FEV1 status (P=0.01) and adjuvant therapy (P=0.01) were independently associated with overall survival. In univariate analysis, adjuvant chemotherapy had an HR of 0.45 (95% CI 0.2 to 0.95), P=0.03.
  • Sex, intraoperative heated chemotherapy and lymph node (N) classification did not appear to affect overall survival. For heated chemotherapy, the univariate HR was 1.13 (95% CI 0.53 to 2.43), P=0.75.
  • Patients who achieved complete resection had numerically longer survival, but the difference was not statistically significant (Table 2: HR 0.63, 95% CI 0.3 to 1.33, P=0.23).
• The authors' conclusion: The authors concluded that pleurectomy decortication for sarcomatoid mesothelioma can be performed with low 30-day mortality, and that most patients derive limited benefit. In their view, a small subset, such as patients with early T-stage disease and preserved lung function, may still be suitable candidates as part of multimodality treatment.
• Limitations the authors state:
  • Retrospective design and small sample size.
  • Any proposed prognostic associations need cautious interpretation and validation in larger studies.

Topics

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Mesothelioma, Pleural Mesothelioma, Prognosis, High-Volume Center, Chemotherapy, Median Overall Survival, FEV1.

Related studies

• A Trimodality, Four-Step Treatment including Chemotherapy, Pleurectomy/Decortication and Radiotherapy in Early-Stage Malignant Pleural Mesothelioma: A Single-Institution Retrospective Case Series Study — G. Vicidomini, C.M. Della Corte, et al. (2021)
• Pleurectomy/decortication is superior to extrapleural pneumonectomy in the multimodality management of patients with malignant pleural mesothelioma — L. Lang-Lazdunski, A. Bille, et al. (2012)
• Patterns of disease progression on 18F-fluorodeoxyglucose positron emission tomography-computed tomography in patients with malignant pleural mesothelioma undergoing multimodality therapy with pleurectomy/decortication — A. Bille, S. Chicklore, et al. (2013)
• MesoTRAP: a feasibility study that includes a pilot clinical trial comparing video-assisted thoracoscopic partial pleurectomy decortication with indwelling pleural catheter in patients with trapped lung due to malignant pleural mesothelioma designed to address recruitment and randomisation uncertainties and sample size requirements for a phase III trial — C. Matthews, C. Freeman, et al. (2019)
• A feasibility study of induction pemetrexed plus cisplatin followed by pleurectomy/decortication aimed at macroscopic complete resection for malignant pleural mesothelioma — M. Shimokawa, S. Hasegawa, et al. (2013)
• Feasibility and safety of extended pleurectomy/decortication for malignant pleural mesothelioma. A single group experience — F. Falanga, P. Rinaldi, et al. (2022)

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