Combining ‘Extended’ P/D Surgery and Heated Chemotherapy for Pleural Mesothelioma

Two of the emerging treatment options for mesothelioma are evolutions of other methods. “Extended” pleurectomy/decortication surgery is a more aggressive version of the standard P/D operation. Heated chemotherapy is a unique variation of the long-used cancer therapy.

In a recent study, one hospital analyzed whether these two novel approaches could be combined to further improve patients’ survival.

A report published in Translational Lung Cancer Research details how extended pleurectomy/decortication with heated chemotherapy can help patients with pleural mesothelioma live for three years or longer. The study compares this multimodal treatment approach to others, such as using extrapleural pneumonectomy surgery, which is the other main type of surgery for pleural mesothelioma.

Pleural mesothelioma is the most common type of mesothelioma. It forms in the lining of the lungs, called the pleura, and usually spreads to the lungs. The average survival is 12-16 months with chemotherapy. Surgery can improve the average survival to around two years.

 

What Is Extended Pleurectomy/Decortication Surgery?

Extended pleurectomy/decortication (P/D) is a more aggressive version of normal P/D surgery. In the regular version of P/D, doctors remove the pleura, which is the lining of the lungs and where pleural mesothelioma cancer forms. Doctors also look for any diseased tissue that can be safely removed from the lung cavity.

Extended P/D involves partial or total removal of the diaphragm and the pericardium (lining around the heart). The intent is to remove any areas that may have individual cancer cells or small tumors.

 

What Is Heated Chemotherapy?

Heated chemotherapy is a variation of the standard cancer treatment used for decades.

Chemotherapy for mesothelioma is traditionally given to patients through an IV and into their bloodstream. Chemotherapy drugs travel through the bloodstream to the tumor site and can attack rapidly growing cells, such as blood cells and cells of the digestive tract.

When cells of the digestive tract are affected by chemotherapy, it may cause nausea and vomiting, which are common side effects of chemotherapy. Standard chemotherapy also requires multiple cycles, usually in three-week intervals.

Hot chemotherapy delivers the drugs directly into the area where cancer exists. It also does not require multiple sessions or “cycles,” instead being done during surgery to make treatment more efficient.

For pleural mesothelioma, patients receive heated intrathoracic chemotherapy (HITHOC). The medical team delivers hot, liquid chemotherapy drugs directly into the thoracic cavity, or chest cavity, where pleural mesothelioma forms and spreads.

 

Impressive Survival Results for Extended P/D and HITHOC Together

There were 182 cases included in the study. They were split into three groups:

• 69 patients underwent extrapleural pneumonectomy (EPP) surgery with chemotherapy before the operation and radiation therapy after. Combining surgery, chemotherapy and radiation is called “trimodal treatment” and is a common strategy for pleural mesothelioma.
• 57 patients underwent extended P/D surgery followed by HITHOC. This is a novel multimodal treatment approach.
• 56 patients received just chemotherapy.

Most of the patients (85%) were male, and the patients receiving surgery were much younger than those receiving just chemotherapy.

Looking just at survival, extended P/D with HITHOC was the best approach. The median survival for patients in this group was 38 months, which far exceeds the usual survival for people diagnosed with pleural mesothelioma.

The median survival for the patients receiving EPP surgery with chemotherapy before and radiation after was 24 months. The chemotherapy-only group’s median survival was nearly 16 months.