Pleurectomy/decortication and adjuvant therapy for malignant mesothelioma

Our plain-English summary of Pleurectomy/decortication and adjuvant therapy for malignant mesothelioma, by V.W. Rusch (Chest, 1993).

The study

• Author: V.W. Rusch
• Journal: Chest
• Published: 1993;103(4 Suppl):382S-384S
• Cited by: 60 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma is an uncommon and usually fatal cancer, for which there is no standard treatment. However, surgical resection remains the mainstay of treatment because of the inability to treat the entire hemithorax effectively with radiation and the lack of effective chemotherapy drugs. Extrapleural pneumonectomy is the only technically feasible operation for patients who have bulky local tumor and chronic entrapment of the lung, but pleurectomy/decortication is associated with a lower operative morbidity and mortality, and seems to lead to an equally good survival in patients who have early-stage disease. Because of the high risk of local recurrence after surgical resection by either extrapleural pneumonectomy or pleurectomy/decortication, efforts have been directed at developing effective adjuvant treatment. Radiation given postoperatively after pleurectomy/decortication has led to a minimal improvement in survival and to significant side effects. Adjuvant chemotherapy is considered investigational but is currently being evaluated in a clinical trial using high-dose intrapleural and systemic chemotherapy after pleurectomy/decortication. Additional well-designed prospective trials are needed to alter the dismal outcome of this disease.

In plain English

This 1993 article by an author at Memorial Sloan-Kettering Cancer Center in New York was an overview of pleurectomy/decortication (removing tumor from the chest lining while leaving the lung in place) and added treatments for malignant mesothelioma. It did not study asbestos exposure. Most of the figures it gave came from earlier studies. In a Lung Cancer Study Group trial of 83 patients, 2-year survival was 33% after extrapleural pneumonectomy, 20% after pleurectomy/decortication and 18.5% for patients treated without surgery. The article reported no significant difference in overall survival among these three groups. In 105 patients treated at Memorial Sloan-Kettering from 1976 to 1988 with pleurectomy/decortication and radiation, median survival was 12.6 months. The article also gave early results from an ongoing trial of pleurectomy/decortication followed by chemotherapy. Of 23 patients followed past the immediate postoperative period, with median follow-up of 11.2 months, 12 were alive and free of disease, 2 were alive with disease and 6 had died of disease. The author concluded that the regimen appeared feasible but that it was too early to compare its survival with earlier 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: Narrative overview/review article on pleurectomy/decortication and adjuvant therapy, summarizing earlier studies and giving interim results of an ongoing trial at the author's institution
• Who was studied: Patients with malignant mesothelioma in the studies described, including 32 patients registered in an ongoing Memorial Sloan-Kettering Cancer Center trial, 25 of whom underwent pleurectomy/decortication and intrapleural chemotherapy
• Exposure: Not studied. The article treats asbestos only as background: many patients have impaired lung function from smoking and asbestos exposure, and many worked in shipbuilding or construction
• Main results:
  • In the earlier Lung Cancer Study Group trial (83 patients), as described in this article, 2-year survival was 33% for extrapleural pneumonectomy patients, 20% for pleurectomy/decortication patients and 18.5% for patients treated nonsurgically
  • In that trial there was no significant difference in overall survival among the three groups, although extrapleural pneumonectomy patients had significantly better disease-free survival
  • In that trial, 3 extrapleural pneumonectomy patients died after surgery, an operative mortality rate of 15%
  • In an earlier Memorial Sloan-Kettering series of 105 patients treated with pleurectomy/decortication and radiation from 1976 to 1988, overall median survival was 12.6 months
  • In that series, a subset with epithelial histology and complete removal of gross tumor had a median survival of 22.5 months
  • In that series, radiation pneumonitis occurred in 12 patients and radiation pericarditis in 8
  • In the ongoing trial of pleurectomy/decortication plus chemotherapy, 23 patients were followed beyond the immediate postoperative period. At median follow-up of 11.2 months, 12 were alive and free of disease, 2 were alive with disease and 6 had died of disease
• The authors' conclusion: The author concluded that the intensive combined-modality regimen appeared feasible, and that careful staging, better chemotherapy and more prospective trials are needed
• Limitations the authors state:
  • The author stated it was too early to know how the new regimen compares with the institution's historic control regimens in overall survival
  • The author stated that without an accurate staging system, treatment results are almost impossible to compare

Topics

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

Medical terms in this study, explained in our Lexicon: Pleurectomy/Decortication (P/D), Adjuvant Therapy, Malignant Mesothelioma, Surgical Resection, Hemithorax, Chemotherapy, Extrapleural Pneumonectomy (EPP), Clinical Trial.

Related studies

• Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine followed by adjuvant chemotherapy in patients with malignant pleural mesothelioma — L. Lang-Lazdunski, A. Bille, et al. (2011)
• Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma — E. Taioli, A.S. Wolf, et al. (2015)
• Pleurectomy/decortication for palliation in malignant pleural mesothelioma: results of surgery — O. Soysal, N. Karaoğlanoğlu, et al. (1997)
• Clinical Outcomes With Recurrence After Pleurectomy/Decortication for Malignant Pleural Mesothelioma — A. Nakamura, T. Takuwa, et al. (2020)
• Extrapleural Pneumonectomy Versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma — N. Zhou, D.C. Rice, et al. (2022)
• Extended Pleurectomy and Decortication for Malignant Pleural Mesothelioma Is an Effective and Safe Cytoreductive Surgery in the Elderly — T. Williams, H. Duraid, et al. (2015)

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