Study: Pleurectomy/Decortication Effective in Multimodal Therapy for Mesothelioma
One of the great questions in contemporary mesothelioma treatment is whether pleurectomy/decortication or extrapleural pneumonectomy is the more effective surgical arm for patients with malignant mesothelioma. Different surgeons hold conflicting opinions on this question, but definitive guidance is still not available to recommend one procedure over the other. In light of this situation, physicians in Germany conducted a study to investigate the specific efficacy of pleurectomy/decortication in multimodality therapy and their results compare favorably with prior studies on the efficacy of EPP and multimodal therapy.
The physicians enrolled 35 patients with histologically-confirmed pleural mesothelioma. The staging breakdown was as follow: ten patients with Stage I disease, 6 with Stage II, 17 with Stage III and 2 patients with Stage IV. 25 Patients presented with epithelioid mesothelioma.
The treatment plan of the study stipulated pleurectomy/decortication as the surgical modality, followed by four cycles of pemetrexed and cisplatin. Radiation therapy to the chest wall and mediastinum commenced four to six weeks after surgery. Of the 35 patients who started the study, 33 completed the full treatment plan. One patient died as a result of the surgery and one died as a result of chemotherapy toxicity.
The study results demonstrated overall median survival at 33.2 months. The 1-year survival rate was reported at 75%, the 2-year survival rate at 61% and the 3-year survival was reported as 43%. Due to these excellent results, the physicians concluded that pleurectomy/decortication is effective in multimodal treatments and they call for large, multi-center studies on this treatment.
The physicians presented their findings on May 3, 2009 at the 2009 European Multidisciplinary Conference in Thoracic Oncology (EMCTO).