Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Outcomes of the Multimodal Treatment of Malignant Pleural Mesiothelioma: The Role of Surgery

  • Na, Bub-Se (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Ji Seong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hyun, Kwanyong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Park, In Kyu (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kang, Chang Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Young Tae (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2017.06.27
  • Accepted : 2017.09.01
  • Published : 2018.02.05
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Abstract

Background: The treatment of malignant pleural mesothelioma (MPM) is challenging, and multimodal treatment including surgery is recommended; however, the role of surgery is debated. The treatment outcomes of MPM in Korea have not been reported. We analyzed the outcomes of MPM in the context of multimodal treatment, including surgery. Methods: The records of 29 patients with pathologically proven MPM from April 1998 to July 2015 were retrospectively reviewed. The treatment outcomes of the surgery and non-surgery groups were compared. Results: The overall median survival time was 10.6 months, and the overall 3-year survival rate was 25%. No postoperative 30-day or in-hospital mortality occurred in the surgery group. Postoperative complications included tachyarrhythmia (n=4), pulmonary thromboembolism (n=1), pneumonia (n=1), chylothorax (n=1), and wound complications (n=3). The treatment outcomes between the surgery and non-surgery groups were not significantly different (3-year survival rate: 31.3% vs. 16.7%, respectively; p=0.47). In a subgroup analysis, there was no significant difference in the treatment outcomes between the extrapleural pneumonectomy group and the non-surgery group (3-year survival rate: 45.5% vs. 16.7%, respectively; p=0.23). Conclusion: Multimodal treatment incorporating surgery did not show better outcomes than non-surgical treatment. A nationwide multicenter data registry and prospective randomized controlled studies are necessary to optimize the treatment of MPM.

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References

  1. Korea Central Cancer Registry, National Cancer Center. Annual report of cancer statistics in Korea in 2014 [Internet]. Sejong: Ministry of Health and Welfare; 2016 [cited 2017 Apr 25]. Available from: http://ncc.re.kr/main.ncc?uri= english/sub04_Statistics.
  2. Antman KH, Blum RH, Greenberger JS, Flowerdew G, Skarin AT, Canellos GP. Multimodality therapy for malignant mesothelioma based on a study of natural history. Am J Med 1980;68:356-62. https://doi.org/10.1016/0002-9343(80)90103-5
  3. Treasure T, Lang-Lazdunski L, Waller D, et al. Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study. Lancet Oncol 2011;12:763-72. https://doi.org/10.1016/S1470-2045(11)70149-8
  4. Flores RM, Pass HI, Seshan VE, et al. Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients. J Thorac Cardiovasc Surg 2008;135: 620-6,626.e1-3. https://doi.org/10.1016/j.jtcvs.2007.10.054
  5. Batirel HF, Metintas M, Caglar HB, et al. Adoption of pleurectomy and decortication for malignant mesothelioma leads to similar survival as extrapleural pneumonectomy. J Thorac Cardiovasc Surg 2016;151:478-84. https://doi.org/10.1016/j.jtcvs.2015.09.121
  6. Byrne MJ, Nowak AK. Modified RECIST criteria for assessment of response in malignant pleural mesothelioma. Ann Oncol 2004;15:257-60. https://doi.org/10.1093/annonc/mdh059
  7. National Comprehensive Cancer Network. Malignant pleural mesothelioma: version 1 [Internet]. Fort Washington (PA): National Comprehensive Cancer Network; 2017 [cited 2017 Jun 2]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/mpm.pdf.
  8. Butchart EG, Ashcroft T, Barnsley WC, Holden MP. Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients. Thorax 1976;31:15-24. https://doi.org/10.1136/thx.31.1.15
  9. Sugarbaker DJ, Flores RM, Jaklitsch MT, et al. Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg 1999;117:54-63. https://doi.org/10.1016/S0022-5223(99)70469-1
  10. Rusch VW, Rosenzweig K, Venkatraman E, et al. A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2001;122:788-95. https://doi.org/10.1067/mtc.2001.116560
  11. Infante M, Morenghi E, Bottoni E, et al. Comorbidity, postoperative morbidity and survival in patients undergoing radical surgery for malignant pleural mesothelioma. Eur J Cardiothorac Surg 2016;50:1077-82. https://doi.org/10.1093/ejcts/ezw215
  12. Hasegawa S, Okada M, Tanaka F, et al. Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial). Int J Clin Oncol 2016;21: 523-30. https://doi.org/10.1007/s10147-015-0925-1
  13. Martini N, Bains MS, Beattie EJ Jr. Indications for pleurectomy in malignant effusion. Cancer 1975;35:734-8. https://doi.org/10.1002/1097-0142(197503)35:3<734::AID-CNCR2820350328>3.0.CO;2-N
  14. Cao C, Tian D, Park J, Allan J, Pataky KA, Yan TD. A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma. Lung Cancer 2014; 83:240-5. https://doi.org/10.1016/j.lungcan.2013.11.026
  15. Rusch VW, Giroux D, Kennedy C, et al. Initial analysis of the international association for the study of lung cancer mesothelioma database. J Thorac Oncol 2012;7:1631-9. https://doi.org/10.1097/JTO.0b013e31826915f1
  16. Rusch VW. Pleurectomy/decortication and adjuvant therapy for malignant mesothelioma. Chest 1993;103(4 Suppl): 382S-384S. https://doi.org/10.1378/chest.103.4_Supplement.382S
  17. Waller DA, Dawson AG. Randomized controlled trials in malignant pleural mesothelioma surgery-mistakes made and lessons learned. Ann Transl Med 2017;5:240. https://doi.org/10.21037/atm.2017.04.05
  18. Vogelzang NJ, Rusthoven JJ, Symanowski J, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 2003;21:2636-44. https://doi.org/10.1200/JCO.2003.11.136
  19. Stahel RA, Riesterer O, Xyrafas A, et al. Neoadjuvant chemotherapy and extrapleural pneumonectomy of malignant pleural mesothelioma with or without hemithoracic radiotherapy (SAKK 17/04): a randomised, international, multicentre phase 2 trial. Lancet Oncol 2015;16:1651-8. https://doi.org/10.1016/S1470-2045(15)00208-9
  20. Takuwa T, Hasegawa S. Current surgical strategies for malignant pleural mesothelioma. Surg Today 2016;46:887-94. https://doi.org/10.1007/s00595-015-1275-3

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  1. Erratum: Outcomes of the Multimodal Treatment of Malignant Pleural Mesiothelioma: The Role of Surgery vol.51, pp.2, 2018, https://doi.org/10.5090/kjtcs.2018.51.2.159