Tuesday, February 23, 2010

Mesothelioma Multimodality Treatment

The European Association for Cardio-Thoracic Surgery reports on three decades worth of experience in surgical multimodality treatment of pleural mesothelioma.

Malignant mesothelioma is an aggressive cancer caused almost exclusively by asbestos exposure. Because of the aggressive nature of the cancer, treating it with only one mode of therapy usually returns a poor response. But when doctors combine therapies such as surgery, chemotherapy and radiation, an improvement in survival is commonly observed.

The study reviews three decades worth of data on pleural mesothelioma patients treated with a multimodality approach in the United Kingdom. Over the course of the three decades, a total of 217 patients were referred for surgical opinion. The 78 patients who only had pleural biopsies were excluded. A total of 139 patients underwent surgical procedure, with 49 undergoing extrapleural pneumonectomy (EPP) and 90 patients undergoing pleurectomy/decortication (PD). Post-operative adjuvant therapy involved chemotherapy and radiotherapy.

The longest survival rates (median 26 months) were observed among patients who underwent a pleurectomy/decortication followed by both chemotherapy and radiotherapy. The extrapleural pneumonectomy, whether or not combined with chemotherapy or radiation, provided no significant survival advantage when compared to the pleurectomy/decortication group. Additionally, EPP not followed with adjuvant therapy was an independent risk factor for decreased survival.

In conclusion, the researchers found that “cytoreductive surgery combined with post-operative adjuvant therapy provided a better survival despite either advanced disease or surgically less fit patients. Thus, pleurectomy/decortication may be the procedure of choice” since neither EPP or PD are curative.

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