Nonselective transarterial chemoperfusion: a palliative treatment for malignant pleural mesothelioma

Our plain-English summary of Nonselective transarterial chemoperfusion: a palliative treatment for malignant pleural mesothelioma, by T.J. Vogl, S. Lindemayr, N.N. Naguib, et al (Radiology, 2013).

The study

• Authors: T.J. Vogl, S. Lindemayr, N.N. Naguib, J. Gurung, N.E. Nour-Eldin, S. Zangos, E.C. Mbalisike
• Journal: Radiology
• Published: 2013;266(2):649-56
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: To evaluate tumor response by means of volumetric assessment, survival, and changes in patient symptoms after the treatment of unresectable and/or recurrent pleural mesothelioma by using regional nonselective transarterial chemoperfusion as a palliative treatment option.

Materials And Methods: This retrospective study was approved by the hospital ethical committee, and all patients signed an informed consent prior to treatment. Thirty-nine patients (mean age, 64.0 years; 10 women and 29 men) with unresectable pleural mesothelioma were treated with repetitive transarterial chemoperfusion between March 2007 and March 2010, with a mean of 2.9 sessions per patient at 4-week intervals. Transarterial chemoperfusion was performed by using mitomycin C, cisplatin, and gemcitabine. Computed tomography findings and patient symptoms were evaluated. Tumor response was evaluated by using Response Evaluation Criteria in Solid Tumors guidelines, and survival was assessed with the Kaplan-Meier method. The change in volume for the partial-response group was tested by using the Wilcoxon signed-rank test.

Results: In 36% of treated tumors (14 of 39), partial response was achieved, and tumor volume decreased from a mean value ± standard deviation of 839.6 mL ± 590.3 (range, 3.9-1972.2 mL) to 137 mL ± 399.8 (range, 0.88-1131.4; P = .00012). In 49% of tumors (19 of 39), stable disease was noted. In 15% of tumors (six of 39), progressive disease was seen. Mean specific growth rate of the tumor was 0.00158% per day. The mean survival time was 14.2 months (range, 2.1-33.1 months) from the start of treatment. For patients with tumors that responded to treatment, mean survival time was 15 months (range, 4.5-33.1 months). Mean time to disease progression was 2.6 months for all tumors, 1.5 months for stable disease, and 1.3 months for progressive disease.

Conclusion: Transarterial chemoperfusion may have the potential to yield positive results and response in the treatment of recurrent and/or unresectable pleural mesothelioma. © RSNA, 2012.

In plain English

This retrospective study described 39 patients (10 women, 29 men; mean age 64.0 years) with unresectable and/or recurrent malignant pleural mesothelioma, treated between March 2007 and 2010. All had already received systemic chemotherapy with cisplatin and pemetrexed. As a palliative treatment, mitomycin C, cisplatin and gemcitabine were injected through a catheter into the aorta or tumor-feeding arteries every 4 weeks, for one to seven sessions (mean 2.9). The article does not discuss asbestos exposure. On CT scans, 14 of 39 patients (36%) had a partial response, 19 (49%) had stable disease and 6 (15%) had progressive disease. From the start of treatment, median survival was 17 months (95% confidence interval 13.7 to 20.2), and mean survival was 14.2 months for all patients and 15 months for responders. Chest pain was reported by 100% of patients at the first session and 33% at the last. No major complications occurred. The authors concluded the treatment "may have the potential" to yield positive results. They named limitations: few patients, nonselective drug delivery, and possible bias because one evaluating radiologist also performed the treatments.

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 study of a single treated group of patients (case series of a palliative treatment)
• Who was studied: 39 patients with unresectable (stage III and IV) and/or recurrent malignant pleural mesothelioma, mean age 64.0 years (range 26–89), 10 women and 29 men, treated between March 2007 and 2010 after failed or poorly tolerated systemic chemotherapy with cisplatin and pemetrexed
• Exposure: No asbestos exposure is reported. The treatment studied was transarterial chemoperfusion: mitomycin C (8 mg/m2), cisplatin (35 mg/m2) and gemcitabine (1000 mg/m2) injected via catheter at 4-week intervals, one to seven sessions (mean 2.9)
• Main results:
  • Partial response (by RECIST guidelines) in 36% of patients (14 of 39)
  • Stable disease in 49% (19 of 39) and progressive disease in 15% (six of 39)
  • In the 14 partial responders, mean tumor volume fell from 839.6 mL to 137.0 mL (P = .00012)
  • Median survival for all patients was 17 months (95% CI: 13.7, 20.2) from the beginning of treatment
  • Mean survival from the beginning of treatment was 14.2 months (range 2.1–33.1) for all patients and 15 months (range 4.5–33.1) for patients whose tumors responded. Mean survival from first diagnosis was 21.1 months (95% CI: 4.2, 38.0)
  • Mean time to disease progression was 2.6 months (range 1–27) for all tumors
  • No significant difference in response between large and small tumors (P = .79) or in survival between the two size groups (P = .06)
  • Percentage of patients with chest pain fell from 100% at the first session to 33% at the last. Dyspnea fell from 100% to 63%, and persistent cough from 33% to 0%
  • After treatment, 74% (29 of 39) had thoracic pain, 18% (7 of 39) gastrointestinal disorders and 15% (6 of 39) dysphagia. No major complications such as arterial hemorrhage occurred
• The authors' conclusion: The authors concluded that transarterial chemoperfusion may have the potential to yield positive results and response in recurrent and/or unresectable pleural mesothelioma
• Limitations the authors state:
  • Relatively small number of patients
  • Drug concentrations in the patients' circulation were not measured
  • The chemoperfusion was nonselective, so drug delivery to the tumor area and pharmacokinetics need further study
  • One evaluating radiologist also performed the treatment, a possible source of bias

Topics

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

Medical terms in this study, explained in our Lexicon: Palliative Care, Pleural Mesothelioma, Unresectable, Informed Consent, Unresectable Pleural Mesothelioma, Mitomycin C, Cisplatin, Gemcitabine.

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