Intraoperative argon-plasma coagulation treatment for patients with malignant pleural mesothelioma

Our plain-English summary of Intraoperative argon-plasma coagulation treatment for patients with malignant pleural mesothelioma, by A. Iyoda, Y. Azuma, T. Sakai, et al (Molecular and Clinical Oncology, 2021).

The study

• Authors: A. Iyoda, Y. Azuma, T. Sakai, S. Koezuka, H. Otsuka, N. Tochigi, K. Isobe, A. Sano
• Journal: Molecular and Clinical Oncology
• Published: 2021;15(3):188
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is often associated with asbestos exposure and carries an extremely poor prognosis. The present study assessed the effectiveness of argon plasma coagulation (APC) treatment in patients with MPM who underwent radical pleural decortication (PD). The clinical data from 11 patients who underwent radical PD treated with APC at Toho University Omori Medical Center from July 2015 to March 2020 were retrospectively analyzed. Clinical features, local recurrence, and clinical prognoses were evaluated. The median overall survival was 18.5 months, and the 1- and 2-year overall survival rates were 71.6 and 43.0%, respectively. One patient survived 5 years but had recurrent tumors. The median disease-free survival was 11.1 months. The 1- and 2-year disease-free survival rates were 49.9 and 12.5%, respectively. Three patients had no recurrences, two of whom were followed continuously (39.6 and 10.2 months). The present study revealed that APC treatment for MPM might be associated with good survival and prognosis. APC as an additional intraoperative treatment for patients with MPM may be further investigated with larger multi-center clinical trials to support its efficacy.

Copyright: © Iyoda et al.

In plain English

This retrospective study from Japan reviewed the records of 11 patients with malignant pleural mesothelioma who had radical pleural decortication between July 2015 and March 2020 at Toho University. This surgery removes the lining of the lung and chest wall while keeping the lung. After removing the lining, surgeons applied argon plasma coagulation (APC), a device that uses argon gas and electrical power, to the chest wall. The authors had used it mainly to stop bleeding and noticed a possible anti-tumor effect. Nine patients also received chemotherapy afterward. The article did not report the patients' asbestos exposure. Median overall survival was 18.5 months, and the 1- and 2-year overall survival rates were 71.6% and 43.0%. Median disease-free survival was 11.1 months. Seven patients had recurrences and three did not. One died in hospital of a cardiac arrhythmia. No complications were linked to APC. The authors concluded that APC may be a potential treatment to add during surgery and called for larger multi-center studies. They noted that their study was small, retrospective and single-arm.

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, single-arm case series with no comparison group; survival estimated by Kaplan-Meier analysis
• Who was studied: All 11 patients with malignant pleural mesothelioma who had radical pleural decortication with APC at Toho University, Tokyo, Japan, from July 2015 to March 2020. There were 7 men and 4 women, with a mean age of 65.8 years (range 48 to 79). By tumor type, 5 were epithelioid, 5 biphasic and 1 sarcomatoid. By pathological stage, 7 were IA, 3 IB and 1 IIIA.
• Exposure: The study examined a treatment, not asbestos exposure. After radical pleural decortication, argon plasma coagulation was applied to the chest wall (ERBE VIO300D/APC2, argon flow 2 l/min, maximum power 80 W). Nine of the 11 patients received adjuvant chemotherapy. No information on asbestos exposure was reported.
• Main results:
  • Median overall survival for the 11 patients was 18.5 months.
  • The 1-year overall survival rate was 71.6% and the 2-year overall survival rate was 43.0%.
  • One patient survived 5 years but had recurrent tumors.
  • Median disease-free survival was 11.1 months. The 1-year disease-free survival rate was 49.9% and the 2-year rate was 12.5%.
  • Recurrence occurred in 7 patients and did not occur in 3. Of the 3 without recurrence, 2 had been followed continuously, for 39.6 and 10.2 months.
  • No complications were associated with APC. One patient died in hospital of a cardiac arrhythmia.
  • Overall and disease-free survival did not differ significantly between patients with epithelioid and non-epithelioid tumors (overall survival P=0.8558; disease-free survival P=0.2559).
• The authors' conclusion: The authors concluded that APC may be a potential treatment to add during surgery for malignant pleural mesothelioma because of its possible anti-tumor effects. They called for evaluation in a larger, multi-center study.
• Limitations the authors state:
  • The study was retrospective, single-arm and small, which limited the generalizability of the results.
  • Because the study was retrospective, patient consent was not obtained; patients could opt out instead.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Prognosis, Median Overall Survival, Overall Survival, Disease-Free Survival, Clinical Trial.

Related studies

• Cold-plasma coagulation in the treatment of malignant pleural mesothelioma: results of a combined approach — M. Hoffmann, H.P. Bruch, et al. (2010)
• Coagulation of human plasma by asbestos fibers — J.A. Hamilton, J.Y. Chan, et al. (1981)
• Body surface area predicts plasma oxaliplatin and pharmacokinetic advantage in hyperthermic intraoperative intraperitoneal chemotherapy — J.C. Leinwand, G.E. Bates, et al. (2013)
• Thermal plasma technology for the treatment of wastes: a critical review — E. Gomez, D.A. Rani, et al. (2009)
• Treatment of airborne asbestos and asbestos-like microfiber particles using atmospheric microwave air plasma — A. Averroes, H. Sekiguchi, et al. (2011)
• Upgrading the glassy slag from waste disposal by thermal plasma treatment — M. Lázár, M. Hnatko, et al. (2018)

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