Management of recurrence after initial surgery for malignant pleural mesothelioma: a mini-review

Our plain-English summary of Management of recurrence after initial surgery for malignant pleural mesothelioma: a mini-review, by S. Halezeroğlu, M. Migliore (Future Oncology, 2015).

The study

• Authors: S. Halezeroğlu, M. Migliore
• Journal: Future Oncology
• Published: 2015;11(24 Suppl):23-7
• Type of article: Review
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Recurrence after surgery in the multimodality therapy for malignant pleural mesothelioma is a common problem. As the majority of patients experience not only local but also distant metastases, a systemic treatment strategy in addition to local control measures remains necessary. Nevertheless, none of the chemotherapy regimens have achieved clinical success. Local management modalities such as stereotaxic treatments, cryoablation and redo surgery on the other hand have promising results, but provide palliative outcomes.

In plain English

This article is a short review (a "mini-review") by two authors from thoracic surgery departments. It is not a new study. It summarized published reports on treating malignant pleural mesothelioma that comes back after surgery given as part of combined treatment. It did not examine asbestos exposure. Citing other work, the authors reported recurrence rates after extrapleural pneumonectomy of between 30 and 77%. Cancer returning only at the original site was seen in 2–19% of cases. They wrote that none of the chemotherapy regimens had achieved clinical success. For cryoablation (freezing tumors), one study published only as an abstract reported a median survival of 11 months in 24 patients. For repeat surgery, one series reported a median survival of 14.5 months in eight patients. In another series of 47 patients, survival was longer when the cancer took longer to return. The authors noted that very little has been reported on repeat surgery. They concluded that local treatments give palliative rather than curative outcomes, and that surgery may be warranted only in selected patients with local-only recurrences.

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: Narrative mini-review of published reports; no new patient data were collected
• Who was studied: Published studies and reports on patients with malignant pleural mesothelioma whose disease recurred after surgery within multimodality treatment
• Exposure: Not applicable: the review concerns treatments for recurrent mesothelioma (second-line chemotherapy, radiotherapy, immunotherapy, stereotactic treatment, cryoablation, reoperation), not asbestos exposure
• Main results:
  • Citing a published study [1], recurrence rates after extrapleural pneumonectomy with chemotherapy or radiation ranged between 30 and 77%
  • In the same cited study, the ipsilateral hemithorax (the same side of the chest) was the most common site of recurrence, occurring in 54% of 169 operated patients
  • The authors wrote that for second-line chemotherapy, response rates varied between 19 and 50%, and that 10 months survival may be achieved
  • A cited University of California at Los Angeles study, published only as an abstract, reported cryoablation in 24 patients with 107 lesions, a median survival of 11 months, and an efficacy rate of 95%
  • Politi and Borzellino reported eight patients who had second surgery after extrapleural pneumonectomy, with a median survival after the second surgery of 14.5 months (range 6–29)
  • Burt et al. (47 patients, chest wall resection) reported a median survival of 8 months if time to recurrence was under 12 months, and 35.8 months if over 24 months
  • Okamoto et al. reported that two of eight patients with recurrence lived more than 20 months
• The authors' conclusion: The authors concluded that no chemotherapy regimen had achieved clinical success, that local treatments showed promising but palliative results, and that surgery may be warranted in selected patients with local-only recurrences
• Limitations the authors state:
  • The authors stated that very little has been reported on reoperation for recurrent mesothelioma
  • The authors stated that no randomized data support radiotherapy after radical surgery
  • The authors stated that there are no data on Cyber-knife and intensity-modulated radiation therapy for recurrence, and only a few cases have been reported

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Multimodal Therapy, Chemotherapy, Palliative Care.

Related studies

• Iterative procedures combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated peritoneal recurrence — M. Vaira, M. Robella, et al. (2014)
• Early recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) — G.H.C. Tan, C.S. Chia, et al. (2018)
• Second surgery for recurrence of malignant pleural mesothelioma after extrapleural pneumonectomy — L. Politi, G. Borzellino (2010)
• Chest wall resection for mesothelioma recurrence after surgery — P. Bertoglio, O. Fanucchi, et al. (2016)
• Local Cancer Recurrence: The Realities, Challenges, and Opportunities for New Therapies — D.A. Mahvi, R. Liu, et al. (2018)
• 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)

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