Online citations, reference lists, and bibliographies.
← Back to Search

Radical Pleurectomy And Chemoradiation For Malignant Pleural Mesothelioma: The Outcome Of Incomplete Resections.

S. Boeluekbas, M. Eberlein, A. Fisseler-Eckhoff, J. Schirren
Published 2013 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
Share
BACKGROUND The type of surgery (radical pleurectomy (RP) vs. extrapleural pneumonectomy (EPP)) remains controversial for malignant pleural mesothelioma (MPM). Macroscopic complete resection (MCR) is a key prognostic factor. It is unclear, if patients undergoing incomplete RP within a standardized multimodality treatment protocols have any advantage in terms of survival and if EPP could theoretically have avoided incomplete resections (R2). METHODS Eighty-eight patients underwent RP followed by chemoradiation from 2002 to 2011 within a prospective multimodality treatment study at a single institution. MCR were compared to R2 within this patient cohort retrospectively. EPP eligibility was assessed retrospectively based on preoperative cardiopulmonary testing and theoretical feasibility to achieve MCR. Kaplan-Meier analyses, log-rank test and Cox regression analyses were used to estimate survival and to determine predictors of survival. RESULTS For the complete patient cohort, median survival (MS) was 26.3 months (mo). MCR could be achieved in 64.8% (57/88). Compared to MCR patients, R2-patients (n = 31, 35.2%) had an inferior overall survival (MS 13 vs. 33 mo, P < .0001), shorter progression-free-survival (MS 9 vs. 16 mo, P < .0001) and inferior survival after disease progression (MS 4 vs. 11 mo; P < .0001), respectively. R2 was associated with advanced p-T-Status (P < .0001), p-N-Status (P = 0.046) and p-IMIG stage (P < .0001). No difference could be observed with regard to age, histology, laterality, surgical morbidity and mortality, respectively. Only 3 out of 88 patients (3.4%) would have been eligible for EPP to achieve MCR. Not resectable T4-disease and impaired cardiopulmonary reserves were the main reasons for ineligibility for EPP in 35.5% (11/31) and 48.4% (15/31), respectively. CONCLUSIONS R2 in patients undergoing RP is associated with inferior outcomes. Only very selected cases would have qualified for EPP to achieve MCR. EPP might be an important surgical extension in selected patients to achieve MCR. There is a need for further investigation of effective intrapleural additive treatment options for patients undergoing R2.
This paper references
10.1510/icvts.2010.256271
Is pleurectomy and decortication superior to palliative care in the treatment of malignant pleural mesothelioma?
I. Zahid (2011)
10.2307/2987141
Statistical methods
G. W. Snedecor (1980)
10.1111/j.1651-2227.1964.tb05158.x
Statistical Methods
G. W. Snedecor (1964)
10.1016/j.jconrel.2011.11.031
Local drug delivery strategies for cancer treatment: gels, nanoparticles, polymeric films, rods, and wafers.
Jesse B. Wolinsky (2012)
10.1016/J.JTCVS.2006.06.044
Impact of lymph node metastasis on outcome after extrapleural pneumonectomy for malignant pleural mesothelioma.
M. D. de Perrot (2007)
10.1097/JTO.0b013e31826915f1
Initial Analysis of the International Association For the Study of Lung Cancer Mesothelioma Database
V. Rusch (2012)
10.3978/j.issn.2225-319X.2012.10.06
Video-atlas of radical pleurectomy for malignant pleural mesothelioma.
S. Boeluekbas (2012)
10.1148/RG.241035058
Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET.
Z. Wang (2004)
10.1200/JCO.2003.11.136
Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma.
N. Vogelzang (2003)
10.1097/JTO.0b013e31824ab6c5
Pleurectomy/Decortication is Superior to Extrapleural Pneumonectomy in the Multimodality Management of Patients with Malignant Pleural Mesothelioma
L. Lang-Lazdunski (2012)
10.1016/j.ijrobp.2011.09.027
Pleural intensity-modulated radiotherapy for malignant pleural mesothelioma.
K. Rosenzweig (2012)
10.6004/JNCCN.2012.0006
[Malignant pleural mesothelioma].
Q. Kong (1983)
10.1093/ejcts/ezs418
Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience.
M. Ried (2013)
10.1097/JTO.0b013e31824de2dc
Prospective Study on Functional Results After Lung-Sparing Radical Pleurectomy in the Management of Malignant Pleural Mesothelioma
S. Boeluekbas (2012)
10.1016/j.ejcts.2008.07.050
Preoperative staging of mesothelioma by 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography fused imaging and mediastinoscopy compared to pathological findings after extrapleural pneumonectomy.
J. Sørensen (2008)
10.1016/j.athoracsur.2012.02.009
Radical pleurectomy and intraoperative photodynamic therapy for malignant pleural mesothelioma.
J. Friedberg (2012)
10.1016/j.athoracsur.2012.05.102
Quality of life after radical pleurectomy decortication for malignant pleural mesothelioma.
N. Mollberg (2012)
10.1016/J.JTCVS.2004.10.034
Integrated computed tomography-positron emission tomography in patients with potentially resectable malignant pleural mesothelioma: Staging implications.
J. Erasmus (2005)
10.1016/S1556-0864(15)31536-7
Macroscopic complete resection: the goal of primary surgery in multimodality therapy for pleural mesothelioma.
D. Sugarbaker (2006)
10.1093/ANNONC/MDM093
Multicenter trial of neo-adjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma.
W. Weder (2007)
10.1097/JTO.0b013e3182208e3f
Recommendations for Uniform Definitions of Surgical Techniques for Malignant Pleural Mesothelioma: A Consensus Report of the International Association for the Study of Lung Cancer International Staging Committee and the International Mesothelioma Interest Group
D. Rice (2011)
10.1016/j.jtcvs.2007.10.054
Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients.
R. Flores (2008)
10.1016/j.athoracsur.2009.05.022
Endoscopic ultrasound-guided fine needle aspiration for staging of malignant pleural mesothelioma.
D. Rice (2009)
10.1016/j.jtcvs.2008.02.069
The impact of lymph node station on survival in 348 patients with surgically resected malignant pleural mesothelioma: implications for revision of the American Joint Committee on Cancer staging system.
R. Flores (2008)
10.1007/978-3-642-82982-6
TNM Classification of Malignant Tumours
L. Sobin (1987)
10.1016/j.ejcts.2009.04.022
The European Respiratory Society and European Society of Thoracic Surgeons clinical guidelines for evaluating fitness for radical treatment (surgery and chemoradiotherapy) in patients with lung cancer.
A. Brunelli (2009)
10.1097/JTO.0b013e31828353d7
Surgery in mesothelioma--where do we go after MARS?
B. Hiddinga (2013)
10.1016/j.lungcan.2009.08.019
Survival after trimodality therapy for malignant pleural mesothelioma: Radical Pleurectomy, chemotherapy with Cisplatin/Pemetrexed and radiotherapy.
S. Boeluekbas (2011)
10.3978/j.issn.2225-319X.2012.10.07
Novel radiation therapy approaches in malignant pleural mesothelioma.
A. Rimner (2012)
10.1111/j.1440-1843.2004.00599.x
Radiology in pleural disease: State of the art
A. L. Evans (2004)



This paper is referenced by
10.1016/j.athoracsur.2018.09.019
Differential Survival Characteristics of Sarcomatoid Subtype in Biphasic Pleural Mesothelioma.
L. Harling (2019)
10.21037/shc.2018.07.01
Advances in mesothelioma imaging and implications for surgical management
K. Blyth (2018)
Surgical treatment for malignant pleural mesothelioma: extrapleural pneumonectomy, pleurectomy/decortication or extended pleurectomy?
P. Hountis (2015)
10.1007/S00761-014-2886-9
Pleuramesotheliome: Multimodales Management als klinische Herausforderung
Rudolf A. Hatz (2015)
10.7314/APJCP.2014.15.21.9165
Caring for patients with malignant pleural mesothelioma in Japan: evaluation of a Palliative Care Educational Program.
Yasuko Nagamatsu (2014)
The Tumor and its Microenvironment in Mesothelioma : The Good, The Bad and The Ugly
R. Cornelissen (2015)
10.1007/978-3-319-40618-3_37
Malignant pleural mesothelioma.
D. Ettinger (2012)
10.2217/LMT.14.26
Systematic review on pleurectomy/ decortication in the multimodality treatment of malignant pleural mesothelioma
S. Sestini (2014)
10.1093/jnci/djaa002
The Role of Neoadjuvant Chemotherapy in Patients with Resectable Malignant Pleural Mesothelioma - An Institutional and National Analysis.
Soraya L. Voigt (2020)
10.6004/JNCCN.2016.0087
NCCN Guidelines Insights: Malignant Pleural Mesothelioma, Version 3.2016.
D. Ettinger (2016)
10.1586/17476348.2016.1171147
The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence
P. Bertoglio (2016)
10.1093/ejcts/ezv403
The effects of an intentional transition from extrapleural pneumonectomy to extended pleurectomy/decortication.
A. Sharkey (2016)
10.1016/j.jtho.2016.04.028
Consensus Report of the 2015 Weinman International Conference on Mesothelioma
M. Carbone (2016)
10.1016/j.jtcvs.2017.12.131
Macroscopic complete resection is not associated with improved survival in patients with malignant pleural mesothelioma
H. Batırel (2018)
10.1007/978-3-030-40679-0_41
Approaches and Surgical Techniques in the Pleural Tumors
A. Taşçı (2020)
10.1093/ejcts/ezw045
The management of the diaphragm during radical surgery for malignant pleural mesothelioma.
A. Sharkey (2016)
10.12659/MSM.906910
Effects of Moisture Content and Loading Profile on Changing Properties of Bone Micro-Biomechanical Characteristics
B. Wang (2018)
10.1002/jcb.24642
Malignant Mesothelioma: Development to Therapy
Joyce K. Thompson (2014)
10.1007/978-1-4471-6404-3_50
Pleurectomy Versus Radical Pleuropneumonectomy for Malignant Pleural Mesothelioma
S. R. Carr (2014)
10.1016/j.ctrv.2015.05.001
The established and future biomarkers of malignant pleural mesothelioma.
V. Panou (2015)
Semantic Scholar Logo Some data provided by SemanticScholar