Surgery Most Successful with Early Stage Mesothelioma

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Research on Surgery in Treating Pleural Mesothelioma

May 28, 2004 — Japanese researchers recently reported good results with a group of pleural mesothelioma patients who underwent surgery to treat the disease (World J Surg Oncol. 2004 May 5; 2(1): 11. Epub 2004 May 05). The mesothelioma was epithelial, a common type in which the cells are cube–shaped and uniform.

Surgeons performed extrapleural pneumonectomies on 10 patients. An extrapleural pneumonectomy removes portions of the lung, the parietal pleura (the lining of the lung), the pericardium (the lining of the heart), and the diaphragm. Extrapleural pneumonectomy is best used in early mesothelioma when the disease has not spread to the chest wall, to lymph nodes, or to other areas.

The patients received chemotherapy drugs before and after surgery. All were treated with the standard chemotherapy drug cisplatin, which is a platinum compound. Some groups also received gemcitabine and vinorelbine. Other were treated with a combination of cisplatin, gemcitabine, and tegafur/uracil. Almost half were treated with radiation.

Six patients had stage III mesothelioma, three had stage II, and one had stage I, according to the mesothelioma staging system used at the Brigham and Women’s Hospital in Boston (Cancer Control. 1997 Jul; 4(4): 326–334; J Thorac Cardiovasc Surg. 1999 Jan; 117(1): 54–63). This staging scheme allows for four stages, from the earliest cancer, stage I, to the most advanced, stage IV. Patients with stage I disease have tumors that may be surgically removed and no affected lymph nodes. Stage II refers to resectable tumors plus affected lymph nodes. Stage III includes some tumors that may not be easily removed because they extend into the diaphragm or the space in the chest between the pleural sacs of the lungs called the mediastinum. Stage IV describes disease in which the tumors have spread.

The survival in patients with stage II–III disease was 37% at two years, and 80% for those with stage I disease. Stage I patients who received gemcitabine, vinorelbine, and cisplatin did the best, even returning to a fairly normal life after surgery, according to the study authors.

The researchers discussed the articles of Dr. David Sugarbaker, a pioneer in using extrapleural pneumonectomy to treat mesothelioma. Dr. Sugarbaker’s mesothelioma patients who were in stage I of the disease had 46% survival rate five years after undergoing extrapleural pneumonectomies (J Thorac Cardiovasc Surg. 1999 Jan; 117(1): 54–63). The expected survival of mesothelioma patients who only receive supportive care is between 4 and 12 months.

Although the results of the paper are promising, only ten patients took part in the study. Dr. Sugarbaker’s studies looked at 183 cases, of which 31 were stage I mesothelioma patients (Chest. 1999 Dec; 116 (6 Suppl): 450S–454S). Some controversy remains about putting patients through the rigors of extensive surgery, and extrapleural pneumonectomy may only prove suitable for a limited subset of pleural mesothelioma patients.

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