Radiofrequency Ablation Effectively Treated Focal Recurrence of Mesothelioma

Our plain-English summary of Radiofrequency Ablation Effectively Treated Focal Recurrence of Mesothelioma, by A. Nakamura, T. Takuwa, M. Hashimoto, et al (The Annals of Thoracic Surgery, 2018).

The study

• Authors: A. Nakamura, T. Takuwa, M. Hashimoto, N. Kondo, H. Takaki, M. Fujiwara, K. Yamakado, S. Hasegawa
• Journal: The Annals of Thoracic Surgery
• Published: 2018;105(6):e265-e267
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 55-year-old man with malignant pleural mesothelioma underwent multimodality treatment comprising induction chemotherapy followed by extrapleural pneumonectomy and radiation therapy. After 2.5 years, focal recurrence occurred, with computed tomography revealing a tumor in the left cardiophrenic angle. Surgery was considered a problem for the patient because of the previous extrapleural pneumonectomy and difficult tumor location. Radiofrequency ablation was therefore performed; the course was uneventful, and there was no recurrence. Radiofrequency ablation should be considered an option to treat recurrence of malignant pleural mesothelioma.

Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This case report from Hyogo College of Medicine, Japan, described one 55-year-old man with malignant pleural mesothelioma. It did not report asbestos exposure. He first had pemetrexed and cisplatin chemotherapy, then extrapleural pneumonectomy (removal of the lung and its lining on one side), then radiation to that side of the chest. Two and a half years after surgery, scans showed a tumor on the other side of the chest, in the left cardiophrenic angle. The authors wrote that this suggested spread of the mesothelioma, but it was not confirmed by tissue examination. Four more cycles of chemotherapy did not work. The authors considered surgery a problem for him, so the tumor was treated with radiofrequency ablation, which destroys tissue with heat from a CT-guided electrode. No complications such as collapsed lung or bleeding occurred around the procedure. Afterward CT showed the tumor had shrunk, and PET/CT showed no FDG tracer uptake at the treated tumor. He was followed for 2 years without recurrence or further chemotherapy. The authors concluded that radiofrequency ablation should be considered an option for treating recurrence of malignant pleural mesothelioma.

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 (one patient)
• Who was studied: One 55-year-old man with malignant pleural mesothelioma, treated at Hyogo College of Medicine, Japan. The pleural biopsy showed epithelioid type. The surgical specimen showed biphasic type. The article does not give treatment dates.
• Exposure: The article does not report any asbestos exposure. The treatment described was radiofrequency ablation under real-time CT fluoroscopic guidance. An electrode with 2 cm exposed was placed at the center of the tumor, and energy was applied for 10 minutes.
• Main results:
  • After induction chemotherapy the patient had a partial response and underwent extrapleural pneumonectomy. Pathology showed biphasic mesothelioma, p-T3N0M0, p-Stage IB.
  • Two and a half years after surgery, a tumor appeared in the left cardiophrenic angle, on the side opposite the original cancer. The authors wrote that this suggested possible focal distant metastasis of the mesothelioma.
  • Four cycles of pemetrexed and cisplatin chemotherapy for the recurrence did not produce a response.
  • The authors considered surgery a problem because of the patient's poor performance status, his previous treatment including extrapleural pneumonectomy, and the difficult tumor location.
  • Radiofrequency ablation was technically successful, with no complications around the time of the procedure such as pneumothorax or bleeding.
  • After ablation, CT showed a significant reduction of the tumor. FDG-PET/CT showed no evidence of FDG accumulation at the tumor.
  • The patient was followed for 2 years after ablation without recurrence or further chemotherapy.
• The authors' conclusion: The authors concluded that radiofrequency ablation should be considered an option for treating recurrence of malignant pleural mesothelioma. They believed this was the first reported case of its use for focal recurrence of the disease.
• Limitations the authors state:
  • The authors state that the tumor treated as a recurrence was not confirmed by tissue examination.

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: Mesothelioma, Pleural Mesothelioma, Chemotherapy, Extrapleural Pneumonectomy (EPP).

Related studies

• Clinical Outcomes With Recurrence After Pleurectomy/Decortication for Malignant Pleural Mesothelioma — A. Nakamura, T. Takuwa, et al. (2020)
• Second surgery for recurrence of malignant pleural mesothelioma after extrapleural pneumonectomy — L. Politi, G. Borzellino (2010)
• Cyberknife radiosurgery for focal paravertebral recurrence after radical pleurectomy/decortication in malignant pleural mesothelioma — L. Lang-Lazdunski, S. Barrington, et al. (2012)
• High-dose-rate surface brachytherapy to boost elongated, curvilinear incisional scars after extrapleural pneumonectomy for malignant pleural mesothelioma treated with adjuvant intensity-modulated radiation therapy — L.A. Doyle, T.N. Showalter, et al. (2010)
• 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)
• Soluble Mesothelin-Related Peptides to Monitor Recurrence After Resection of Pleural Mesothelioma — B.M. Burt, H.S. Lee, et al. (2017)

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