Surgery followed by intracavitary plus systemic chemotherapy in malignant pleural mesothelioma

Our plain-English summary of Surgery followed by intracavitary plus systemic chemotherapy in malignant pleural mesothelioma, by M. Colleoni, F. Sartori, F. Calabro, et al (Tumori, 1996).

The study

• Authors: M. Colleoni, F. Sartori, F. Calabro, P. Nelli, G. Vicario, G. Sgarbossa, F. Gaion, L. Bortolotti, L. Toniolo, P. Manente
• Journal: Tumori
• Published: 1996;82(1):53-6
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims And Background: Malignant mesothelioma is associated with a median survival of 4 to 12 months. Data from the literature indicate that single modality treatment (surgery or intrapleural and/or systemic chemotherapy) does not significantly affect survival.

Methods: We therefore evaluated a combined approach consisting of surgery (pleurectomy + diaphragmatic or pericardial resection), intrapleural chemotherapy with cisplatin (100 mg/m2) and cytarabine (1,000 mg/m2) for 4 h immediately after pleurectomy, and systemic chemotherapy consisting of epirubicin (60 mg/m2) and mitomycin-C (10 mg/m2) day 1 every 4 weeks for 4 cycles.

Results: Twenty patients were enrolled in the study and were evaluable. Thirteen cases had residual gross disease after pleurectomy and 7 patients only minimal disease. Median time to disease progression was 7.4 months, and median survival was 11.5 months (range, 2-25+). No treatment-related death have been observed. Side effects after intracavitary chemotherapy included renal toxicity, anaemia and pain. Myelosuppression and alopecia were recorded during systematic chemotherapy.

Conclusions: The results of the study indicate that the schedule is feasible, with encouraging results in terms of survival for patients with minimal residual disease after surgery.

In plain English

This Italian study tested the feasibility of a combined treatment for malignant pleural mesothelioma. Twenty patients treated between July 1990 and January 1994 had surgery to strip the pleura (pleurectomy/decortication). Cisplatin and cytarabine were then placed directly into the chest cavity, followed by four planned cycles of epirubicin and mitomycin-C given into a vein. Fifteen of the 20 patients had a recorded history of asbestos exposure. Surgery left only minimal disease in 7 patients and gross disease in 13. No treatment-related deaths occurred. One patient developed kidney failure requiring dialysis, which the authors attributed to inadequate hydration. Median time to progression was 7.4 months and median survival was 11.5 months (range 2 to 25+). Patients with minimal residual disease had a median survival of 24.5 months, compared with 10 months for those with bulky residual disease. The authors concluded the approach was feasible with no serious side effects. They noted that survival was similar to that often seen in untreated patients. They also noted that minimal residual disease is itself a prognostic factor, so no definite conclusion could be drawn about the chemotherapy's effect on survival.

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: single-group clinical treatment study whose primary aim was feasibility (no comparison group)
• Who was studied: 20 patients with biopsy-proven, previously untreated malignant pleural mesothelioma, enrolled July 1990 to January 1994 at centers in Castelfranco Veneto and Padova, Italy
• Exposure: Treatment, not asbestos, was the exposure studied: pleurectomy/decortication, then cisplatin (100 mg/m2) and cytarabine (1,000 mg/m2) instilled into the pleural space immediately after surgery, then systemic epirubicin (60 mg/m2) and mitomycin-C (10 mg/m2) every 28 days for 4 cycles
• Main results:
  • 15 of the 20 patients (75%) had a recorded history of asbestos exposure
  • Surgery achieved minimal residual disease in 7 patients; 13 had gross residual disease
  • No toxic (treatment-related) deaths were observed in the 20 patients
  • One patient had grade IV kidney side effects after surgery plus intracavitary chemotherapy, attributed to inadequate hydration, and needed dialysis
  • 53 cycles of systemic chemotherapy were given, with a median of 4 cycles per patient; side effects of systemic chemotherapy were generally mild and reversible
  • Median time to progression for the whole group was 7.4 months (range 4-10 months)
  • Median survival for the whole group was 11.5 months (range 2-25+)
  • Median survival was 24.5 months for patients with minimal residual disease and 10 months for those with bulky residual disease
• The authors' conclusion: The authors concluded that the combined approach is feasible and has no serious side effects, with encouraging survival in patients with minimal residual disease after surgery
• Limitations the authors state:
  • The median survival was similar to that often seen in untreated patients, so the authors stated that no clear improvement can be attributed to the treatment
  • Minimal residual disease after surgery is itself an independent prognostic factor, so the better survival in that group cannot be credited to the chemotherapy

Topics

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

Medical terms in this study, explained in our Lexicon: Chemotherapy, Pleural Mesothelioma, Malignant Mesothelioma, Median Survival, Pericardial, Cisplatin, Disease Progression.

Related studies

• A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma — V. Rusch, L. Saltz, et al. (1994)
• Cytoreductive surgery with selective versus complete parietal peritonectomy followed by hyperthermic intraperitoneal chemotherapy in patients with diffuse malignant peritoneal mesothelioma: a controlled study — D. Baratti, S. Kusamura, et al. (2012)
• A Phase II Trial of Nivolumab With Chemotherapy Followed by Maintenance Nivolumab in Patients With Pleural Mesothelioma After Surgery: The NICITA Study Protocol — R. Shah, L.V. Klotz, et al. (2021)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• Importance of excision repair cross-complementation group 1 and ribonucleotide reductase M1 as prognostic biomarkers in malignant pleural mesothelioma treated with platinum-based induction chemotherapy followed by surgery — L. Frischknecht, M. Meerang, et al. (2015)
• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)

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