Pathologic complete remission of malignant pleural mesothelioma after combined modality treatment: a case report

Our plain-English summary of Pathologic complete remission of malignant pleural mesothelioma after combined modality treatment: a case report, by K. Moubax, V. Van Damme, P. Nafteux, et al (Acta Clinica Belgica, 2013).

The study

• Authors: K. Moubax, V. Van Damme, P. Nafteux, M. Van den Heuvel, E. Verbeken, Y. Lievens, K. Nackaerts
• Journal: Acta Clinica Belgica
• Published: 2013;68(5):386-8
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

A 50-year-old patient with malignant pleural mesothelioma (epithelial subtype, clinically staged cT1bN0M0) underwent a combined modality treatment, including induction chemotherapy, followed by extrapleural pneumonectomy (EPP) and radical radiotherapy. After pathologic examination of the surgical specimen, a complete remission (pT0N0) was observed. The complete disappearance of solid tumour tissue after induction chemotherapy is a rarely observed and documented finding in the combined modality treatment of malignant pleural mesothelioma. The real prognostic value of the pathologic complete remission of a malignant pleural mesothelioma definitely needs to be further evaluated in a larger series of patients.

In plain English

This was a case report about one 50-year-old man with left-sided malignant pleural mesothelioma of the epithelial subtype, clinically staged cT1bN0M0. The article did not describe whether or how he had been exposed to asbestos. He received three cycles of induction chemotherapy with cisplatin and pemetrexed. A PET-CT scan afterwards showed a slight decrease in pleural thickness and in uptake of the tracer FDG. He then had a left extrapleural pneumonectomy, with no complications after surgery. No tumour was visible in the removed tissue. Microscopic examination found scar tissue but no remaining tumour cells, which the authors staged as pT0N0M0, a pathologic complete remission. He then received radiotherapy to the left chest: 54 Gy in 30 fractions of 1.8 Gy. He lived 73 months after surgery with no documented relapse of his mesothelioma. He developed chronic cardiac failure and died after a cardiac arrest. The authors concluded that this combined treatment may occasionally lead to a complete pathologic remission in few patients. They said the prognostic value of such a remission needs further study in a larger series of patients.

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)
• Who was studied: One 50-year-old man with left-sided malignant pleural mesothelioma, epithelial subtype, clinically staged cT1bN0M0
• Exposure: The article does not report the patient's asbestos exposure history or any fiber type. The article is about his treatment: induction chemotherapy (cisplatin and pemetrexed), then extrapleural pneumonectomy, then radiotherapy.
• Main results:
  • Before treatment, the patient's mesothelioma was staged cT1bN0M0 after negative videomediastinoscopy and laparoscopy
  • The patient received 3 cycles of cisplatin 75 mg/m2 and pemetrexed 500 mg/m2, given once every 21 days. A PET-CT afterwards showed a slight decrease in pleural thickness and in FDG uptake
  • A left extrapleural pneumonectomy was performed without postoperative complications
  • In the surgical specimen, no tumour was seen by eye. Microscopic examination found scar tissue but no residual tumour cells. The final pathologic stage was pT0N0M0
  • After surgery, the patient received radiotherapy to the left side of the chest: 54 Gy in 30 fractions of 1.8 Gy
  • The patient survived 73 months after surgery with no documented relapse of mesothelioma, checked by PET-CT every 6 months
  • The patient's physical condition became increasingly impaired by chronic cardiac failure, and he died after a cardiac arrest
• The authors' conclusion: The authors concluded that trimodality treatment (chemotherapy before surgery, surgery, and radiotherapy after surgery) may occasionally lead to a complete pathologic remission in few patients
• Limitations the authors state:
  • The authors stated that the prognostic value of a pathologic complete remission after combined modality treatment still needs to be evaluated in a larger series of patients

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, Chemotherapy, Extrapleural Pneumonectomy (EPP).

Related studies

• Intensity-modulated radiotherapy after extrapleural pneumonectomy in the combined-modality treatment of malignant pleural mesothelioma — A. Chi, Z. Liao, et al. (2011)
• Chemotherapy induced pathologic complete response in malignant pleural mesothelioma: a review and case report — C. Bech, J.B. Sørensen (2010)
• Genetically engineered oncolytic Newcastle disease virus effectively induces sustained remission of malignant pleural mesothelioma — G.R. Silberhumer, P. Brader, et al. (2010)
• Extrapleural pneumonectomy in the treatment of epithelioid malignant pleural mesothelioma: novel prognostic implications of combined N1 and N2 nodal involvement based on experience in 529 patients — D.J. Sugarbaker, W.G. Richards, et al. (2014)
• Cold-plasma coagulation in the treatment of malignant pleural mesothelioma: results of a combined approach — M. Hoffmann, H.P. Bruch, et al. (2010)
• Prognostic factors in the treatment of malignant pleural mesothelioma at a large tertiary referral center — R.M. Flores, M. Zakowski, et al. (2007)

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