Intrathoracic chemo-thermotherapy with radiofrequency waves after extrapleural pneumonectomy for malignant pleural mesothelioma

Our plain-English summary of Intrathoracic chemo-thermotherapy with radiofrequency waves after extrapleural pneumonectomy for malignant pleural mesothelioma, by T. Tokunaga, M. Higashiyama, J. Okami, et al (Interactive Cardiovascular and Thoracic Surgery, 2011).

The study

• Authors: T. Tokunaga, M. Higashiyama, J. Okami, J. Maeda, A. Fujiwara, K. Kodama
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2011;13(3):267-70
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Although multimodal treatment is advocated for malignant pleural mesothelioma (MPM), a standard therapeutic regimen has not been established. This study evaluated the outcome of our aggressive treatment including extrapleural pneumonectomy (EPP) and postoperative intrathoracic chemo-thermotherapy (PICT). Moreover, we assessed the association between the clinical effect and an in vitro chemosensitivity test. Eleven patients with MPM underwent treatment including EPP followed by PICT using 8 MHz radiofrequency waves. In vitro chemosensitivity was examined using the collagen gel droplet embedded culture drug-sensitivity test (CD-DST). Complete resection was performed in nine patients. More than two courses of PICT with sufficient heating were completely performed in seven patients. There was no perioperative mortality. Grade 3 or 4 toxicity was not recognized. The median overall survival was 19 months, and the median local relapse-free survival was 17 months. Local recurrence was recognized in four patients (36.4%). Of these patients, three had received incomplete PICT. Four patients with complete PICT including a CD-DST-sensitive chemoagent did not develop local recurrence. Of three patients who received complete PICT including a CD-DST-resistant chemoagent, one tumor recurred locally. The present multimodal treatment including EPP and PICT is promising in local control for MPM. Furthermore, CD-DST may provide clinically useful information for MPM.

In plain English

This report described 11 patients with malignant pleural mesothelioma treated at one cancer center in Osaka, Japan, between 1995 and 2008. The article did not discuss asbestos exposure. All 11 had surgery to remove the lung, pleura and diaphragm (extrapleural pneumonectomy). Two to four weeks later they received cisplatin or carboplatin placed directly into the chest, while the chest was heated with radiofrequency waves. The four most recent patients also had radiotherapy. Complete resection was achieved in 9 of the 11 patients. No patient died around the time of surgery, and none had grade 3 or 4 toxicity from the chest treatment. Median survival was 19 months. Local recurrence occurred in 14.3% of the seven patients who completed the chest treatment and in 75% of the four who did not. The authors concluded that this combined treatment is promising for local control of the disease. They noted that, without a control group, its effect on survival was not shown, and that a randomized study is needed.

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-institution report of a series of treated patients (case series), with no control group
• Who was studied: 11 patients with malignant pleural mesothelioma (six males, five females; average age 54.8 years) who underwent extrapleural pneumonectomy followed by postoperative intrathoracic chemo-thermotherapy. They were drawn from 41 patients who had surgical diagnosis or resection for this disease at Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan, from 1995 to 2008. Ten had stage III disease and one had stage IV.
• Exposure: Not an asbestos exposure study; the article does not describe asbestos exposure. The 'exposure' was treatment: extrapleural pneumonectomy, then cisplatin (50–100 mg) or carboplatin (450 mg) injected into the chest cavity with 60 minutes of 8 MHz radiofrequency heating. Hemithoracic radiotherapy (54 Gy) was added in the most recent four patients.
• Main results:
  • Complete resection was achieved in 9 (81.8%) of the 11 patients.
  • No patient died in the perioperative period.
  • No patient had grade 3 or 4 toxicity from the chest treatment.
  • Nausea occurred in five patients after the chest treatment.
  • For all 11 patients, median survival was 19 months.
  • For all 11 patients, one-year survival was 63.6% and two-year survival was 18.2%.
  • Two patients were alive without recurrence at 23 and 63 months. The other nine died of recurrence.
  • Median local relapse-free survival was 17 months. One-year and two-year local relapse-free survival rates were 54.5% and 9.1%.
  • Local recurrence occurred in 14.3% of the seven patients who completed the chest treatment, compared with 75% of the four patients whose treatment was incomplete.
  • Four patients had a drug that the lab sensitivity test (CD-DST) rated as effective against their tumor cells. All four completed the chest treatment and none had local recurrence.
  • Three patients completed the chest treatment with a drug the lab test rated as resistant. One of these three (case 3) had local recurrence.
  • Local recurrence was 28.6% (two of seven) in patients without radiotherapy and 50% (two of four) in patients with radiotherapy.
• The authors' conclusion: The authors concluded that the combined treatment of extrapleural pneumonectomy and postoperative intrathoracic chemo-thermotherapy is promising for local control of malignant pleural mesothelioma, and that the in vitro sensitivity test may provide clinically useful information.
• Limitations the authors state:
  • There was no control group, so the treatment's effect on survival was not demonstrated.
  • It was not known whether radiotherapy helped local control.
  • The authors stated that a randomized study is needed to confirm the treatment's effectiveness.

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, Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma, Collagen, Median Overall Survival.

Related studies

• Malignant pleural mesothelioma: a therapeutic challenge — G. Dimitrakakis, T. BinEsmael, et al. (2011)
• 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)
• Managing the pneumonectomy space after extrapleural pneumonectomy: postoperative intrathoracic pressure monitoring — A.S. Wolf, F.L. Jacobson, et al. (2010)
• Extrapleural pneumonectomy after induction chemotherapy: perioperative outcome in 251 mesothelioma patients from three high-volume institutions — O. Lauk, M.A. Hoda, et al. (2014)
• Extrapleural pneumonectomy for malignant pleural mesothelioma: outcomes of treatment and prognostic factors — T.D. Yan, M. Boyer, et al. (2009)
• Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial) — S. Hasegawa, M. Okada, et al. (2016)

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