Pleurectomy/decortication and hyperthermic intrapleural chemotherapy for malignant pleural mesothelioma: initial experience

Our plain-English summary of Pleurectomy/decortication and hyperthermic intrapleural chemotherapy for malignant pleural mesothelioma: initial experience, by M. Migliore, D. Calvo, A. Criscione, et al (Future Oncology, 2015).

The study

• Authors: M. Migliore, D. Calvo, A. Criscione, S. Palmucci, G. Fuccio Sanzà, R. Caltabiano, C. Spatola, G. Privitera, M.M. Aiello, H.S. Parra, N. Ciancio, G. Di Maria
• Journal: Future Oncology
• Published: 2015;11(24 Suppl):19-22
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Cytoreductive surgery and hyperthermic intraoperative intrapleural chemotherapy (HITHOC) are a known option for malignant pleural mesothelioma (MPM). This prospective study was started to prove that pleurectomy/decortication and HITHOC could be successfully performed in a low volume center. Criteria of inclusion were a proven diagnosis of MPM, early-stage disease and good performance status. Six consecutive patients were enrolled. After pleurectomy/decortication, intrapleural cisplatin was administered for 60 min at 42.5 °C. Wedge resections and diaphragmatic reconstruction were added in two and one patient, respectively. Morbidity was 16.6%. Mortality was nil. Hospital stay was 7.8 days. Mean survival was 21.5 months (range: 6-30). This small experience confirms that pleurectomy/decortication and HITHOC are a good therapeutic option in the multimodality treatment of MPM. A randomized controlled trial is necessary.

In plain English

This prospective study from Catania, Italy, a center the authors called low-volume, followed six consecutive patients (five men, one woman, mean age 67) with malignant pleural mesothelioma confined to the chest from October 2011. All had lung-sparing pleurectomy/decortication, then heated cisplatin (42.5°C, 60 minutes) circulated in the chest cavity, then chemoradiotherapy. Early-stage disease was sought, but one patient was staged T2N2 before surgery and one T4N0 at pathology. Five (83.3%) had prior asbestos exposure; fiber types were not reported. Five tumors were epithelial, one biphasic. No intraoperative complications or postoperative deaths occurred. Morbidity was reported as 16.6%. Separately, the article listed anemia in one patient and a creatinine rise in one with kidney failure, without explaining how these related to that figure. All visible tumor was removed in four patients. Mean survival at writing was 21.5 months (range 6 to 30). Four patients were alive; one died at 6 months from intestinal blockage, one at 24 months. The authors concluded the approach could give good results in a low-volume center, called it a small experience, and said a randomized controlled trial is necessary.

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: Prospective case series (preliminary results of a single-center surgical study)
• Who was studied: Six consecutive patients with malignant pleural mesothelioma confined to the chest, treated at Policlinico Hospital, Catania, Italy, from October 2011. Five were male and one female, with a mean age of 67 years (range 59–77). Five had epithelial and one had biphasic mesothelioma.
• Exposure: Treatment studied: pleurectomy/decortication by uniportal video-assisted thoracic surgery with a minithoracotomy, followed by hyperthermic intrapleural cisplatin at 120 mg/m2 for 60 minutes at 42.5°C, then adjuvant chemoradiotherapy within 6 weeks. Five of six patients had prior asbestos exposure; fiber types were not reported.
• Main results:
  • Five of the six patients (83.3%) had prior exposure to asbestos.
  • Staging varied across the six patients. In Table 1, patient 2 was staged T2N2 both before surgery and at pathology, and patient 1 was staged T2N0 before surgery but T4N0 at pathology.
  • There were no intraoperative complications.
  • There was no postoperative mortality.
  • Morbidity was reported as 16.6% for the six patients.
  • The results section separately lists two postoperative complications: anemia in one patient, and a rise in creatinine requiring diuretics in the patient with renal failure. The article does not explain how these relate to the 16.6% morbidity figure.
  • Macroscopic complete resection was achieved in four of the six patients.
  • Mean hospital stay was 7.9 days (range 6–10), as printed in the results section.
  • Mean survival for the six patients was 21.5 months (range 6–30) at the time of writing.
  • Four patients were alive. One died at 6 months from intestinal occlusion and one died after 24 months of follow-up.
• The authors' conclusion: The authors concluded that, within a multimodality program, lung-sparing surgery combined with intraoperative hyperthermic intrapleural chemotherapy could give good results also in a low-volume center.
• Limitations the authors state:
  • The authors describe the study as a small experience.
  • The authors state that a randomized controlled trial is necessary.

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: Pleurectomy/Decortication (P/D), Chemotherapy, Pleural Mesothelioma, Cytoreductive Surgery, Performance Status, Cisplatin.

Related studies

• Cytoreductive surgery and hyperthermic intrapleural chemotherapy for malignant pleural diseases: preliminary experience — M. Migliore, D. Calvo, et al. (2015)
• A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma — V. Rusch, L. Saltz, et al. (1994)
• Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine, prophylactic radiotherapy, and systemic chemotherapy in patients with malignant pleural mesothelioma: a 10-year experience — L. Lang-Lazdunski, A. Bille, et al. (2015)
• Interim results of pleurectomy/decortication and intraoperative intrapleural hyperthermic cisplatin perfusion for patients with malignant pleural mesothelioma intolerable to extrapleural pneumonectomy — H. Ishibashi, M. Kobayashi, et al. (2015)
• Local and systemic exposure of cisplatin during hyperthermic intrathoracic chemotherapy perfusion after pleurectomy and decortication for treatment of pleural malignancies — M. Ried, T. Potzger, et al. (2013)
• 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)

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