Treatment for recurrence after extrapleural pneumonectomy for malignant pleural mesothelioma: A single institution experience

Our plain-English summary of Treatment for recurrence after extrapleural pneumonectomy for malignant pleural mesothelioma: A single institution experience, by T. Okamoto, T. Yano, A. Haro, et al (Thoracic Cancer, 2013).

The study

• Authors: T. Okamoto, T. Yano, A. Haro, T. Yoshida, M. Kohno, Y. Maehara
• Journal: Thoracic Cancer
• Published: 2013;4(1):66-70
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma (MPM) is a relatively rare, aggressive neoplasm associated with asbestos exposure. Extrapleural pneumonectomy (EPP) is often performed for resectable MPM as part of a multidisciplinary treatment; however, available data on treatments for recurrence after EPP are limited.

Methods: The clinical records of consecutive MPM patients who underwent EPP at our institution from 2001 to 2010 were retrospectively reviewed. There were 10 patients who underwent EPP with or without perioperative chemotherapy; of these, recurrence was observed in eight patients.

Results: The overall median survival time and time to recurrence were 49.6 months and 15.4 months, respectively, after EPP. The first recurrence occurred within the ipsilateral thorax in four patients. These patients all underwent local treatments for their recurrence, including surgery or radiotherapy and with or without systemic chemotherapy. Other first recurrences were seen in the peritoneal space of two patients and in the contralateral lung of two patients. These patients received platinum-based systemic chemotherapy for their recurrence. The median survival time after the first recurrence was 17.8 months, and the 2-year survival rate was 23.4%.

Conclusions: Most patients who underwent EPP developed tumor recurrences. Direct tumor extension may be a major mechanism of recurrence. Aggressive treatment for recurrent MPM after EPP, including locoregional control and/or systemic chemotherapy, was important for achieving long-term survival.

© 2012 Tianjin Lung Cancer Institute and Wiley Publishing Asia Pty Ltd.

In plain English

This brief report from Kyushu University Hospital in Japan reviewed the clinical records of all 10 consecutive patients (nine men, one woman) who had extrapleural pneumonectomy for malignant pleural mesothelioma between April 2001 and March 2010. In this operation, the lung was removed together with the thickened pleura (the chest lining) and the pericardium and diaphragm on the same side. The article did not report on the patients' asbestos exposure. Across all 10 patients, median survival after surgery was 49.6 months. The cancer came back in eight patients (80%), at a median of 15.4 months after surgery. In four, the first recurrence was on the same side of the chest. These patients were treated locally with surgery or radiotherapy, with or without chemotherapy. Two recurred in the peritoneal space (abdominal lining) and two in the opposite lung, and these four received platinum-based chemotherapy. After the first recurrence, median survival was 17.8 months and the 2-year survival rate was 23.4%. The authors concluded that most recurrences could have come from direct spread of the original tumor, and that aggressive treatment of recurrences was important for long-term 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: Retrospective review of clinical records (case series) at a single institution, published as a brief report
• Who was studied: 10 consecutive patients with malignant pleural mesothelioma (nine men, one woman; median age 58, range 48 to 66) who underwent extrapleural pneumonectomy at Kyushu University Hospital, Fukuoka, Japan, April 2001 to March 2010. Eight had epithelial and two biphasic tumors. Eight patients who later had a recurrence were followed in detail.
• Exposure: No asbestos exposure data were reported. The study examined treatment: extrapleural pneumonectomy with or without perioperative cisplatin-based chemotherapy, and the treatments given for recurrence (surgery, radiotherapy, platinum-based chemotherapy).
• Main results:
  • In all 10 patients, median survival after extrapleural pneumonectomy was 49.6 months. The 2-year survival rate was 78.7% and the 5-year survival rate 27.8%.
  • Recurrence occurred in 8 of the 10 patients (80%), at a median of 15.4 months after surgery.
  • The first recurrence was in the same side of the chest in four patients (two chest wall, two mediastinum); these patients received local treatment. In the other four it was in the peritoneal space (two) or the opposite lung (two); these patients received platinum-based chemotherapy.
  • Among the eight patients with recurrence, median survival after the first recurrence was 17.8 months and the 2-year survival rate was 23.4%.
  • Three patients lived longer than 20 months after recurrence. Two of them had a first recurrence in the mediastinum or chest wall that was removed by surgery and followed by cisplatin-based chemotherapy. The third had lung metastases and received chemotherapy only.
• The authors' conclusion: The authors concluded that most patients developed recurrences after extrapleural pneumonectomy, and that most recurrences could have resulted from direct extension of the primary tumor. They also concluded that aggressive treatment of recurrences, including local control and/or systemic chemotherapy, was important for long-term survival.

Topics

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma, Neoplasm, Asbestos Exposure, Chemotherapy, Median Survival, Thorax.

Related studies

• Should we continue to offer extrapleural pneumonectomy to selected mesothelioma patients? A single center experience comparing surgical and non-surgical management — M. Baud, A. Bobbio, et al. (2014)
• Is less also better? A single-institution experience on treatment of early stage Malignant Pleural Mesothelioma — P. Bertoglio, M.C. Ambrogi, et al. (2017)
• 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)
• Extrapleural pneumonectomy after induction chemotherapy: perioperative outcome in 251 mesothelioma patients from three high-volume institutions — O. Lauk, M.A. Hoda, et al. (2014)
• Hemithoracic radiation therapy after extrapleural pneumonectomy for malignant pleural mesothelioma: Toxicity and outcomes at an Australian institution — A. Bece, M.M. Tin, et al. (2015)
• Second surgery for recurrence of malignant pleural mesothelioma after extrapleural pneumonectomy — L. Politi, G. Borzellino (2010)

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