Malignant pleural mesothelioma treated with cytoreductive video-assisted thoracic surgery plus hyperthermic intrathoracic chemotherapy: a case report

Our plain-English summary of Malignant pleural mesothelioma treated with cytoreductive video-assisted thoracic surgery plus hyperthermic intrathoracic chemotherapy: a case report, by D. Li, Y. Cao, F. Petrella, et al (Journal of Thoracic Disease, 2024).

The study

• Authors: D. Li, Y. Cao, F. Petrella, Y. Zou
• Journal: Journal of Thoracic Disease
• Published: 2024;16(11):8133-8141
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is primarily treated with a combination therapy based on lung pleurectomy in the early stage or pemetrexed combined with platinum-based chemotherapy in the late stage. However, these standard therapies do not significantly improve survival and are associated with significant adverse reactions.

Case Description: In February 2017, a 63-year-old male patient was admitted to Department of Thoracic Surgery, The Third Affiliated Hospital of Chongqing Medical University coughing for 1 month and experienced chest tightness and chest pain for 2 days. After admission, the patient underwent thoracic puncture drainage and was diagnosed with stage IIIb (c-T4NxM0) MPM. The patient subsequently underwent left pleural biopsy under single-port thoracoscopy, followed by cytoreductive surgery plus hyperthermic intrathoracic chemotherapy as a local treatment for controlling pleural effusion. At a postoperative follow-up in October 2017, we found that he had recurrent MPM with multiple nodules on the left pleura. Despite this, the patient declined further antitumor treatment. In April 2020, the patient was readmitted to The Third Affiliated Hospital of Chongqing Medical University for left-sided chest pain and was observed to have an enlarged tumor in the left pleural according to further imaging examination. Fortunately, no further pleural effusion has been observed since then. Subsequently, the patient was administered a combination of immunotherapy and cisplatin-pemetrexed chemotherapy as systemic therapy for six cycles, along with subsequent mono immunotherapy as maintenance therapy for three additional cycles. Following this, the left pleural tumor shrank significantly, and the patient achieved partial remission. However, due to the patient's irregular treatment adherence, the patient returned for systemic immunotherapy therapy for four cycles in November 2021, and a slight reduction of the pleural tumor was achieved. Once again, the patient discontinued treatment until he experienced left-sided chest pain and partial tumor enlargement in February 2023. Another three cycles of immunotherapy were administered, but the pleural tumor continued to grow. In June 2023, the patient succumbed to respiratory failure caused by a pulmonary infection. Overall, the patient's survival time was 76 months.

Conclusions: Cytoreductive video-assisted thoracic surgery plus hyperthermic intrathoracic chemotherapy followed by systemic chemo-immunotherapy can effectively control pleural effusion, prolong patient survival, and improve the quality of life in patients with MPM.

2024 AME Publishing Company. All rights reserved.

In plain English

This article was a case report about one patient: a 63-year-old man admitted to The Third Affiliated Hospital of Chongqing Medical University, China, in February 2017 with cough, chest tightness and chest pain. He was diagnosed with stage IIIb malignant pleural mesothelioma, later confirmed by surgical pathology as the epithelioid type. The article did not mention asbestos or any other exposure history. He had video-assisted thoracoscopic surgery to remove as much visible tumor as possible. Heated chemotherapy (cisplatin and doxorubicin) was then placed in the chest cavity, followed by one cycle of chemotherapy. The mesothelioma recurred by October 2017, and the authors reported that fluid around the lung did not come back during follow-up. From 2020 he received the immunotherapy drug sintilimab with cisplatin-pemetrexed chemotherapy, and the tumor partly shrank. His treatment was interrupted several times, and the tumor later grew. He died in June 2023 of respiratory failure caused by a lung infection. The authors reported his overall survival as 76 months. The authors concluded that this combined approach may be effective, but the report describes one patient and cannot show how often such results occur.

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 (single patient), followed by a multidisciplinary team discussion
• Who was studied: One 63-year-old man admitted in February 2017 to The Third Affiliated Hospital of Chongqing Medical University, China, with stage IIIb (c-T4NXM0) malignant pleural mesothelioma, epithelioid type
• Exposure: The article does not report any asbestos or other exposure history for the patient; it concerns treatment (cytoreductive video-assisted thoracic surgery, hyperthermic intrathoracic chemotherapy with cisplatin and doxorubicin, then sintilimab with cisplatin-pemetrexed)
• Main results:
  • During surgery, 200 mL of sterile water at 48 degrees Celsius mixed with cisplatin 100 mg was instilled into the pleural cavity, followed by 120 mg of doxorubicin, for 30 minutes
  • The mesothelioma recurred in the left pleura by October 2017, and the patient declined further treatment at that time
  • No recurrence of pleural effusion was observed during the 6-year follow-up
  • After six cycles of sintilimab plus cisplatin-pemetrexed and three cycles of sintilimab alone, the left pleural tumor shrank and the patient achieved partial remission by RECIST 1.1
  • After treatment interruption, four cycles of sintilimab from November 2021 gave a slight tumor reduction, suggesting stable disease
  • After a further interruption, the tumor enlarged in February 2023 and kept growing despite three more cycles of sintilimab
  • The patient died in June 2023 of respiratory failure caused by a pulmonary infection; the authors reported overall survival of 76 months
• The authors' conclusion: The authors concluded that cytoreductive VATS plus hyperthermic intrathoracic chemotherapy is an effective local treatment for controlling pleural effusion caused by MPM, and that chemo-immunotherapy may serve as an effective systemic treatment for controlling tumor progression
• Limitations the authors state:
  • The patient did not follow systemic treatment regularly, which the authors say led to inconsistent treatment effect
  • Complete removal of visible tumor is difficult with VATS cytoreduction, so residual tumor cells may remain
  • The lung-injury risks of heated intrathoracic chemotherapy and of immune-related pneumonitis may overlap and need monitoring

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Cytoreductive Surgery, Thoracic Surgery, Intrathoracic, Chemotherapy, Pemetrexed (Alimta), Pleural Biopsy, Thoracoscopy.

Related studies

• Comparison of video-assisted pleurectomy/decortication surgery plus hyperthermic intrathoracic chemotherapy with VATS talc pleurodesis for the treatment of malignant pleural mesothelioma: A pilot study — M. Migliore, M. Fiore, et al. (2023)
• First report of pleural mesothelioma treated with cytoreductive surgery and hyperthermic intrathoracic chemotherapy in Kazakhstan: a case report — K. Nurtas, D. Alexandr, et al. (2026)
• Cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy in patients with malignant pleural mesothelioma or pleural metastases of thymoma — E. de Bree, S. van Ruth, et al. (2002)
• Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience — M. Ried, T. Potzger, et al. (2013)
• Pharmacokinetics of doxorubicin and cisplatin used in intraoperative hyperthermic intrathoracic chemotherapy after cytoreductive surgery for malignant pleural mesothelioma and pleural thymoma — S. van Ruth, O. van Tellingen, et al. (2003)
• Hyperthermic Intrathoracic Chemotherapy (HITOC) after Cytoreductive Surgery for Pleural Malignancies-A Retrospective, Multicentre Study — M. Ried, J. Kovács, et al. (2021)

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