Mesothelioma surgery is one of the best ways to eliminate and defeat this aggressive cancer, but not every patient is a candidate for a radical surgery. There are a few criteria doctors use to determine eligibility: health, age, stage of the mesothelioma and the cell type (epithelioid cells or sarcomatoid cells).
Another criteria could be whether the patient responds well to neoadjuvant therapy.
Mesothelioma is a rare cancer diagnosed in approximately 2,500 people in the U.S. each year. It forms in either the lining of the lungs (pleural mesothelioma) or the lining of the abdominal cavity (peritoneal mesothelioma).
Neoadjuvant therapy is a medical term for therapy given to the patient before surgery. Neoadjuvant therapies for mesothelioma include chemotherapy, immunotherapy and radiation therapy. The intent of neoadjuvant therapy is to decrease the volume of major tumors and eliminate any smaller, individual tumors.
A recent study in the medical publication Frontiers in Oncology – the study was published on the U.S. National Library of Medicine website – indicates that the success of neoadjuvant therapy will dictate the long-term survival impact of mesothelioma surgery, and can help doctors determine whether their patient would benefit from a radical surgery even with the possible complications.
Why Some Patients Do Not Have Mesothelioma Surgery
There are two main surgeries for pleural mesothelioma and one surgery for peritoneal mesothelioma.
The two surgeries for pleural mesothelioma are extrapleural pneumonectomy (EPP) and pleurectomy with decortication (P/D). EPP removes all of the diseased lung, while P/D spares the lung and removes just the pleura. Both surgeries are aggressive and require weeks of recovery time for the patient.
The surgery for peritoneal mesothelioma is cytoreduction with HIPEC. Doctors remove all visible tumors and diseased tissue from the abdominal cavity and then administer heated chemotherapy to bathe the area in cancer-killing drugs. The recovery time for this surgery is also multiple weeks.
Doctors may suggest patients do not have surgery if their health status is not ideal. They might not have good enough respiratory function to endure having just one lung, or they might have comorbidities, such as heart conditions or weight issues. If the doctor feels the patient might suffer from a surgery complication or might not have a good quality of life – along with not extending survival – then an operation might not be the best treatment plan.
Poor Response to Neoadjuvant Therapy Leads to Shorter Survival After Surgery
Doctors in the study learned that the patient’s response to neoadjuvant therapy can hint at whether they will have a lengthy survival after surgery. The study included 99 patients with pleural mesothelioma who had neoadjuvant therapy and then an aggressive surgery (either EPP or P/D).
According to the results, patients who responded poorly to neoadjuvant therapy had a median survival of 15.8 months following surgery. The contrast was significant, as patients who responded well to neoadjuvant therapy had a median survival of 38 months (3 years, 2 months) following surgery.
You may have additional questions about the benefits and risks of mesothelioma surgery or other therapies. Our team includes medical experts who can answer these questions and help you find experienced mesothelioma specialists at top-ranked cancer centers for second opinions on treatment and more.
Please email registered nurse Karen Ritter at firstname.lastname@example.org to get connected with the help you deserve.
- Radiographic response to neoadjuvant therapy in pleural mesothelioma should serve as a guide for patient selection for cytoreductive operations. Frontiers in Oncology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/37637041/. Accessed: 09/06/2023.
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