Intrapleural chemotherapy for patients with incompletely resected malignant mesothelioma: the UCLA experience

Our plain-English summary of Intrapleural chemotherapy for patients with incompletely resected malignant mesothelioma: the UCLA experience, by J.D. Lee, S. Perez, H.J. Wang, et al (Journal of Surgical Oncology, 1995).

The study

• Authors: J.D. Lee, S. Perez, H.J. Wang, R.A. Figlin, E.C. Holmes
• Journal: Journal of Surgical Oncology
• Published: 1995;60(4):262-7
• Cited by: 33 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

From 1986 to 1993, 15 patients with malignant pleural mesothelioma were treated by pleurectomy/decortication and intrapleural cisplatin (100 mg/m2) and cytosine arabinoside (1,200 mg). All patients were without known extrathoracic disease and had a mean age of 63 +/- 7.9 years (range 51-78); 13 were male. Histologic subtype of disease were epithelial (47%), sarcomatoid (27%), and mixed-biphasic (27%). The major morbidity and mortality rates were 13% and 0%, respectively. The mean length of hospital stay was 6.5 +/- 2.1 days. Postoperatively, adjuvant chemotherapy and radiation therapy were given to 46% and 73% of the patients respectively. Median survival from date of treatment was 11.5 months. Those patients with an epithelial histologic subtype experienced significantly improved survival compared to those of sarcomatoid subtype (P = 0.024). Whether adjuvant chemotherapy or radiation therapy were given had no significant effect on survival. These data suggest that although this treatment regimen can be administered with very limited morbidity and no mortality, the role of this approach in the treatment of malignant pleural mesothelioma appears limited and cannot currently be recommended.

In plain English

This paper reported the University of California at Los Angeles (UCLA) experience with one treatment for malignant pleural mesothelioma. From January 1986 to September 1993, 17 consecutive patients were treated. Two were later found to have a different cancer and were excluded, leaving 15 (13 men, 2 women, mean age 63.5). Asbestos exposure, usually at work, was reported in 80%. Surgeons removed as much visible tumor as they could (pleurectomy/decortication). They then poured two drugs, cisplatin and cytosine arabinoside, into the chest cavity. Serious complications occurred in 2 of 15 patients, and no patient died from the treatment. The disease came back in the chest in all 15 patients, and 14 had died of mesothelioma at the time of reporting. Median survival, measured from the date of treatment, was 11.5 months (95% confidence interval 6.0 to 13.0 months). Patients with the epithelial subtype survived significantly longer than those with the sarcomatoid subtype (P = 0.024), which the authors attributed to slower disease rather than to the treatment. Added chemotherapy or radiation had no significant effect on survival. The authors concluded they could not recommend this regimen at the current time.

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 case series of consecutive patients given an investigational treatment, with no comparison group
• Who was studied: 15 patients with biopsy-proven, previously untreated malignant pleural mesothelioma without known disease outside the chest, treated at UCLA from January 1986 to September 1993 (13 men, 2 women, mean age 63.5, range 51-78). Of 17 treated, 2 were reclassified as metastatic pleural adenocarcinoma and excluded. Subtypes: epithelial 7 (47%), sarcomatoid 4 (27%), biphasic-mixed 4 (27%).
• Exposure: The study examined a treatment, not asbestos exposure: pleurectomy/decortication followed by intrapleural cisplatin (100 mg/m2) and cytosine arabinoside (1,200 mg). Prior asbestos exposure, usually occupational, was reported in 80% of patients. No fiber types were given.
• Main results:
  • Major morbidity (grade 3 or 4 toxicity) occurred in 2 of 15 patients (13%). There were no treatment-related deaths.
  • All 15 patients had local recurrence, and 14 of 15 had died of progressive mesothelioma at the time of reporting.
  • Overall median survival from the date of treatment was 11.5 months for the whole group (95% confidence interval 6.0-13.0 months).
  • Median survival by subtype was 12.0 months for epithelial (n = 7), 10.5 months for mixed-biphasic (n = 4) and 5.9 months for sarcomatoid (n = 4). In the log-rank test, subtype was a prognostic factor (P = 0.046).
  • After adjusting for postoperative chemotherapy and radiation therapy, the epithelial subtype was associated with significantly longer survival than the sarcomatoid subtype (P = 0.024). The epithelial versus biphasic comparison was not statistically significant (P = 0.140).
  • Postoperative chemotherapy (given to 7 of 15) and radiation therapy (given to 11 of 15) had no significant effect on survival. For radiation there was a trend that was not statistically significant (P = 0.097).
  • Among the 12 patients who survived longer than 6 months, the median time to clinical recurrence was estimated at 7.5 months (range 3-37.5 months).
• The authors' conclusion: The authors concluded that, because local control was poor (100% local failure) and there was no demonstrable survival benefit, they could not recommend this regimen at the current time. They attributed the longer survival of the epithelial subtype to a more slowly progressing disease rather than to the treatment.
• Limitations the authors state:
  • Clinical recurrence was hard to assess because follow-up X-rays have limited sensitivity and surgery causes changes on X-rays.
  • Only one autopsy was performed, so hidden distant spread was probably greatly under-counted.
  • The authors said that any role of the intrapleural chemotherapy in the symptom relief they observed was undefined.

Topics

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

Medical terms in this study, explained in our Lexicon: Chemotherapy, Malignant Mesothelioma, Pleural Mesothelioma, Pleurectomy/Decortication (P/D), Cisplatin, Histological Subtype, Sarcomatoid, Biphasic Mesothelioma.

Related studies

• A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma — V. Rusch, L. Saltz, et al. (1994)
• Pleurectomy/decortication and hyperthermic intrapleural chemotherapy for malignant pleural mesothelioma: initial experience — M. Migliore, D. Calvo, et al. (2015)
• Optimal management of malignant mesothelioma after subtotal pleurectomy: revisiting the role of intrapleural chemotherapy and postoperative radiation — E.R. Sauter, C. Langer, et al. (1995)
• Evolution of locoregional treatment for peritoneal carcinomatosis: single-center experience of 308 procedures of cytoreductive surgery and perioperative intraperitoneal chemotherapy — T.C. Chua, W. Liauw, et al. (2011)
• Platinum-based doublet chemotherapy in pre-treated malignant pleural mesothelioma (MPM) patients: a mono-institutional experience — G. Pasello, S. Nicotra, et al. (2011)
• A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy — J.M. Baumgartner, T.G. Kwong, et al. (2016)

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