Surgical Therapy of Mesothelioma

Chapter
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 189)

Abstract

The treatment of malignant pleural mesothelioma is controversial, particularly regarding the role of surgery. Though well accepted as a diagnostic modality, surgery is also frequently used to establish stage, provide palliation, and perhaps most controversially, to offer cytoreduction with the putative goal of delaying tumor progression and prolonging survival. Pleurectomy/decortication (PD) can achieve macroscopic complete resection; however, the ability to deliver effective postoperative radiation treatment is limited because of the risk of lung toxicity. Accordingly, it has been associated with higher rates of local recurrence compared to extrapleural pneumonectomy (EPP). Extrapleural pneumonectomy generally offers a more complete cytoreduction compared to PD but at the cost of increased morbidity and mortality. Adjuvant hemithoracic radiation is feasible following EPP and in most series local recurrence rates are lower after EPP than PD. There are no convincing data, however, to show that one procedure is superior to the other in terms of survival. Furthermore, no randomized data currently exist that demonstrate a survival benefit to any form of surgical cytoreduction over systemic treatment and supportive care. If cytoreductive surgery does have a beneficial effect on long-term survival, it will most likely be realized in patients with epithelioid tumors without nodal metastases.

References

  1.  1.
    Agarwal PP et al (2006) Pleural mesothelioma: sensitivity and incidence of needle track seeding after image-guided biopsy versus surgical biopsy. Radiology 241(2):589–594PubMedCrossRefGoogle Scholar
  2.  2.
    Allen KB, Faber LP, Warren WH (1994) Malignant pleural mesothelioma. Extrapleural pneumonectomy and pleurectomy. Chest Surg Clin N Am 4(1):113–126PubMedGoogle Scholar
  3.  3.
    Allen AM et al (2007) Influence of radiotherapy technique and dose on patterns of failure for mesothelioma patients after extrapleural pneumonectomy. Int J Radiat Oncol Biol Phys 68(5):1366–1374PubMedCrossRefGoogle Scholar
  4.  4.
    Alvarez JM et al (2009) Bilateral thoracoscopy, mediastinoscopy and laparoscopy, in addition to CT, MRI and PET imaging, are essential to correctly stage and treat patients with mesothelioma prior to trimodality therapy. ANZ J Surg 79(10):734–738PubMedCrossRefGoogle Scholar
  5.  5.
    Arrossi AV et al (2008) Histologic assessment and prognostic factors of malignant pleural mesothelioma treated with extrapleural pneumonectomy. Am J Clin Pathol 130(5):754–764PubMedCrossRefGoogle Scholar
  6.  6.
    Aziz T, Jilaihawi A, Prakash D (2002) The management of malignant pleural mesothelioma; single centre experience in 10 years. Eur J Cardiothorac Surg 22(2):298–305PubMedCrossRefGoogle Scholar
  7.  7.
    Baldini EH et al (1997) Patterns of failure after trimodality therapy for malignant pleural mesothelioma. Ann Thorac Surg 63(2):334–338PubMedCrossRefGoogle Scholar
  8.  8.
    Beattie EJ Jr (1963) The treatment of malignant pleural effusions by partial pleurectomy. Surg Clin North Am 43:99–108PubMedGoogle Scholar
  9.  9.
    Bolukbas S et al (2011) Survival after trimodality therapy for malignant pleural Mesothe­lioma: Radical Pleurectomy, chemotherapy with Cis platin/Pemetrexed and radiotherapy. Lung Cancer 71(1):75–81Google Scholar
  10. 10.
    Brancatisano RP, Joseph MG, McCaughan BC (1991) Pleurectomy for mesothelioma. Med J Aust 154(7):455–457PubMedGoogle Scholar
  11. 11.
    Butchart EG et al (1976) Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients. Thorax 31(1):15–24PubMedCrossRefGoogle Scholar
  12. 12.
    Ceresoli GL et al (2001) Therapeutic outcome according to histologic subtype in 121 patients with malignant pleural mesothelioma. Lung Cancer 34(2):279–287PubMedCrossRefGoogle Scholar
  13. 13.
    Colaut F et al (2004) Pleurectomy/decortication plus chemotherapy: outcomes of 40 cases of malignant pleural mesothelioma. Chir Ital 56(6):781–786PubMedGoogle Scholar
  14. 14.
    Colleoni M et al (1996) Surgery followed by intracavitary plus systemic chemotherapy in malignant pleural mesothelioma. Tumori 82(1):53–56PubMedGoogle Scholar
  15. 15.
    Conlon KC, Rusch VW, Gillern S (1996) Laparoscopy: an important tool in the staging of malignant pleural mesothelioma. Ann Surg Oncol 3(5):489–494PubMedCrossRefGoogle Scholar
  16. 16.
    de Perrot M et al (2007) Impact of lymph node metastasis on outcome after extrapleural pne­umonectomy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 133(1):111–116PubMedCrossRefGoogle Scholar
  17. 17.
    de Perrot M et al (2009) Trimodality therapy with induction chemotherapy followed by extrapleural pneumonectomy and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Clin Oncol 27(9):1413–1418PubMedCrossRefGoogle Scholar
  18. 18.
    Detterbeck FC et al (2007) Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132(3 Suppl):202S–220SPubMedCrossRefGoogle Scholar
  19. 19.
    Edwards JG et al (2007) Right extrapleural pneumonectomy for malignant mesothelioma via median sternotomy or thoracotomy? Short- and long-term results. Eur J Cardio Thorac Surg 31(5):759–764CrossRefGoogle Scholar
  20. 20.
    Eloubeidi MA et al (2005) Endoscopic ultrasound-guided fine needle aspiration of mediastinal lymph node in patients with suspected lung cancer after positron emission tomography and computed tomography scans. Ann Thorac Surg 79(1):263–268PubMedCrossRefGoogle Scholar
  21. 21.
    Erasmus JJ et al (2005) Integrated computed tomography-positron emission tomography in patients with potentially resectable malignant pleural mesothelioma: staging implications. J Thorac Cardiovasc Surg 129(6):1364–1370PubMedCrossRefGoogle Scholar
  22. 22.
    Flores RM et al (2003) Positron emission tomography defines metastatic disease but not locoregional disease in patients with malignant pleural mesothelioma. J Thorac Cardiovasc Surg 126(1):11–16PubMedCrossRefGoogle Scholar
  23. 23.
    Flores RM et al (2007) Prognostic factors in the treatment of malignant pleural mesothelioma at a large tertiary referral center. J Thorac Oncol 2(10):957–965, Official Publication of the International Association for the Study of Lung CancerPubMedCrossRefGoogle Scholar
  24. 24.
    Flores RM et al (2008) Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients. J Thorac Cardiovasc Surg 135(3):620–626PubMedCrossRefGoogle Scholar
  25. 25.
    Friedberg JS et al (2003) A phase I study of Foscan-mediated photodynamic therapy and surgery in patients with mesothelioma. Ann Thorac Surg 75(3):952–959PubMedCrossRefGoogle Scholar
  26. 26.
    Gupta V et al (2005) Hemithoracic radiation therapy after pleurectomy/decortication for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys 63(4):1045–1052PubMedCrossRefGoogle Scholar
  27. 27.
    Hasani A et al (2009) Outcome for patients with malignant pleural mesothelioma referred for Trimodality therapy in Western Australia. J Thorac Oncol 4(8):1010–1016, Official Publication of the International Association for the Study of Lung CancerPubMedCrossRefGoogle Scholar
  28. 28.
    Herth FJ et al (2006) Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax 61(9):795–798PubMedCrossRefGoogle Scholar
  29. 29.
    Hilaris BS et al (1984) Pleurectomy and intraoperative brachytherapy and postoperative radiation in the treatment of malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys 10(3):325–331PubMedCrossRefGoogle Scholar
  30. 30.
    Janes SM et al (2007) Catheter-tract metastases associated with chronic indwelling pleural catheters. Chest 131(4):1232–1234PubMedCrossRefGoogle Scholar
  31. 31.
    Krug LM et al (2009) Multicenter phase II trial of neoadjuvant pemetrexed plus cisplatin followed by extrapleural pneumonectomy and radiation for malignant pleural mesothelioma. J Clin Oncol 27(18):3007–3013PubMedCrossRefGoogle Scholar
  32. 32.
    Lee JD et al (1995) Intrapleural chemotherapy for patients with incompletely resected malignant mesothelioma: the UCLA experience. J Surg Oncol 60(4):262–267PubMedCrossRefGoogle Scholar
  33. 33.
    Lee TT et al (2002) Radical pleurectomy/decortication and intraoperative radiotherapy followed by conformal radiation with or without chemotherapy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 124(6):1183–1189PubMedCrossRefGoogle Scholar
  34. 34.
    Lemaire A et al (2006) Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate. Ann Thorac Surg 82(4):1185–1189, discussion 1189-90PubMedCrossRefGoogle Scholar
  35. 35.
    Lucchi M et al (2007) A phase II study of intrapleural immuno-chemotherapy, pleurectomy/decortication, radiotherapy, systemic chemotherapy and long-term sub-cutaneous IL-2 in stage II-III malignant pleural mesothelioma. Eur J Cardiothorac Surg 31(3):529–533, discussion 533-4PubMedCrossRefGoogle Scholar
  36. 36.
    Martin-Ucar AE et al (2001) Palliative surgical debulking in malignant mesothelioma. Predictors of survival and symptom control. Eur J Cardiothorac Surg 20(6):1117–1121PubMedCrossRefGoogle Scholar
  37. 37.
    Martin-Ucar AE et al (2007) Case-control study between extrapleural pneumonectomy and radical pleurectomy/decortication for pathological N2 malignant pleural mesothelioma. Eur J Cardiothorac Surg 31(5):765–770, discussion 770-1PubMedCrossRefGoogle Scholar
  38. 38.
    Matzi V et al (2004) Polyhematoporphyrin-mediated photodynamic therapy and decortication in palliation of malignant pleural mesothelioma: a clinical pilot study. Interact Cardiovasc Thorac Surg 3(1):52–56PubMedCrossRefGoogle Scholar
  39. 39.
    McCormack PM et al (1982) Surgical treatment of pleural mesothelioma. J Thorac Cardiovasc Surg 84(6):834–842PubMedGoogle Scholar
  40. 40.
    Merritt N et al (2001) Survival after conservative (palliative) management of pleural malignant mesothelioma. J Surg Oncol 78(3):171–174PubMedCrossRefGoogle Scholar
  41. 41.
    Miles EF et al (2008) Intensity-modulated radiotherapy for resected mesothelioma: the Duke experience. Int J Radiat Oncol Biol Phys 71(4):1143–1150PubMedCrossRefGoogle Scholar
  42. 42.
    Monneuse O et al (2003) Long-term results of intrathoracic chemohyperthermia (ITCH) for the treatment of pleural malignancies. Br J Cancer 88(12):1839–1843PubMedCrossRefGoogle Scholar
  43. 43.
    Moskal TL et al (1998) Operation and photodynamic therapy for pleural mesothelioma: 6-year follow-up. Ann Thorac Surg 66(4):1128–1133PubMedCrossRefGoogle Scholar
  44. 44.
    Muers MF et al (2008) Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (MS01): a multicentre randomised trial. Lancet 371(9625):1685–1694PubMedCrossRefGoogle Scholar
  45. 45.
    Pass HI et al (1997) Phase III randomized trial of surgery with or without intraoperative photodynamic therapy and postoperative immunochemotherapy for malignant pleural mesothelioma. Ann Surg Oncol 4(8):628–633PubMedCrossRefGoogle Scholar
  46. 46.
    Pass HI et al (1997) Surgically debulked malignant pleural mesothelioma: results and prognostic factors. Ann Surg Oncol 4(3):215–222PubMedCrossRefGoogle Scholar
  47. 47.
    Pilling JE et al (2004) The case for routine cervical mediastinoscopy prior to radical surgery for malignant pleural mesothelioma. Eur J Cardiothorac Surg 25(4):497–501PubMedCrossRefGoogle Scholar
  48. 48.
    Rea F et al (2007) Induction chemotherapy, extrapleural pneumonectomy (EPP) and adjuvant hemi-thoracic radiation in malignant pleural mesothelioma (MPM): feasibility and results. Lung Cancer 57(1):89–95PubMedCrossRefGoogle Scholar
  49. 49.
    Rice D (2009) Surgery for malignant pleural mesothelioma. Ann Diagn Pathol 13(1):65–72PubMedCrossRefGoogle Scholar
  50. 50.
    Rice TW et al (1994) Aggressive multimodality therapy for malignant pleural mesothelioma. Ann Thorac Surg 58(1):24–29PubMedCrossRefGoogle Scholar
  51. 51.
    Rice DC et al (2005) Extended surgical staging for potentially resectable malignant pleural mesothelioma. Ann Thorac Surg 80(6):1988–1992, discussion 1992-3PubMedCrossRefGoogle Scholar
  52. 52.
    Rice DC et al (2007) Outcomes after extrapleural pneumonectomy and intensity-modulated radiation therapy for malignant pleural mesothelioma. Ann Thorac Surg 84(5):1685–1692, discussion 1692-3PubMedCrossRefGoogle Scholar
  53. 53.
    Rice DC et al (2009) Endoscopic ultrasound-guided fine needle aspiration for staging of malignant pleural mesothelioma. Ann Thorac Surg 88(3):862–868, discussion 868-9PubMedCrossRefGoogle Scholar
  54. 54.
    Richards WG et al (2006) Phase I to II study of pleurectomy/decortication and intraoperative intracavitary hyperthermic cisplatin lavage for mesothelioma. J Clin Oncol 24(10):1561–1567PubMedCrossRefGoogle Scholar
  55. 55.
    Ruffie P et al (1989) Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients. J Clin Oncol 7(8):1157–1168PubMedGoogle Scholar
  56. 56.
    Rusch VW (1995) A proposed new international TNM staging system for malignant pleural mesothelioma. Chest 108(4):1122–1128PubMedCrossRefGoogle Scholar
  57. 57.
    Rusch VW, Piantadosi S, Holmes EC (1991) The role of extrapleural pneumonectomy in malignant pleural mesothelioma. A Lung Cancer Study Group trial. J Thorac Cardiovasc Surg 102(1):1–9PubMedGoogle Scholar
  58. 58.
    Rusch V et al (1994) A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma. J Clin Oncol 12(6):1156–1163PubMedGoogle Scholar
  59. 59.
    Rusch VW et al (2001) A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 122(4):788–795PubMedCrossRefGoogle Scholar
  60. 60.
    Sauter ER et al (1995) Optimal management of malignant mesothelioma after subtotal pleurectomy: revisiting the role of intrapleural chemotherapy and postoperative radiation. J Surg Oncol 60(2):100–105PubMedCrossRefGoogle Scholar
  61. 61.
    Schouwink H et al (2001) Intraoperative photodynamic therapy after pleuropneumonectomy in patients with malignant pleural mesothelioma: dose finding and toxicity results. Chest 120(4):1167–1174PubMedCrossRefGoogle Scholar
  62. 62.
    Schouwink JH et al (2003) The value of chest computer tomography and cervical mediastinoscopy in the preoperative assessment of patients with malignant pleural mesothelioma. Ann Thorac Surg 75(6):1715–1718, discussion 1718-9PubMedCrossRefGoogle Scholar
  63. 63.
    Sioris T et al (2009) Long-term indwelling pleural catheter (PleurX) for malignant pleural effusion unsuitable for talc pleurodesis. Eur J Surg Oncol 35(5):546–551PubMedCrossRefGoogle Scholar
  64. 64.
    Soysal O et al (1997) Pleurectomy/decortication for palliation in malignant pleural mesothelioma: results of surgery. Eur J Cardiothorac Surg 11(2):210–213PubMedCrossRefGoogle Scholar
  65. 65.
    Sugarbaker DJ (2006) Macroscopic complete resection: the goal of primary surgery in multimodality therapy for pleural mesothelioma. J Thorac Oncol 1(2):175–176, Official Publi­cation of the International Association for the Study of Lung CancerPubMedCrossRefGoogle Scholar
  66. 66.
    Sugarbaker DJ et al (1991) Extrapleural pneumonectomy, chemotherapy, and radiotherapy in the treatment of diffuse malignant pleural mesothelioma. J Thorac Cardiovasc Surg 102(1):10–14, discussion 14-5PubMedGoogle Scholar
  67. 67.
    Sugarbaker DJ et al (1999) 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 117(1):54–63, discussion 63-5PubMedCrossRefGoogle Scholar
  68. 68.
    Sugarbaker DJ et al (2004) Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies. J Thorac Cardiovasc Surg 128(1):138–146PubMedCrossRefGoogle Scholar
  69. 69.
    Tilleman TR et al (2009) Extrapleural pneumonectomy followed by intracavitary intraoperative hyperthermic cisplatin with pharmacologic cytoprotection for treatment of malignant pleural mesothelioma: a phase II prospective study. J Thorac Cardiovasc Surg 138(2):405–411PubMedCrossRefGoogle Scholar
  70. 70.
    Tournoy KG et al (2008) Transesophageal endoscopic ultrasound with fine needle aspiration in the preoperative staging of malignant pleural mesothelioma. Clin Cancer Res 14(19):6259–6263PubMedCrossRefGoogle Scholar
  71. 71.
    Treasure T, Sedrakyan A (2004) Pleural mesothelioma: little evidence, still time to do trials. Lancet 364(9440):1183–1185PubMedCrossRefGoogle Scholar
  72. 72.
    Treasure T et al (2006) The MARS trial: mesothelioma and radical surgery. Interact Cardiovasc Thorac Surg 5(1):58–59PubMedCrossRefGoogle Scholar
  73. 73.
    Treasure T et al (2009) The Mesothelioma and Radical surgery randomized controlled trial: the Mars feasibility study. J Thorac Oncol 4(10):1254–1258, Official Publication of the International Association for the Study of Lung CancerPubMedCrossRefGoogle Scholar
  74. 74.
    Trousse DS et al (2009) Is malignant pleural mesothelioma a surgical disease? A review of 83 consecutive extra-pleural pneumonectomies. Eur J Cardiothorac Surg 36(4):759–763PubMedCrossRefGoogle Scholar
  75. 75.
    van Meerbeeck JP et al (2005) Randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma: an intergroup study of the European Organisation for Research and Treatment of Cancer Lung Cancer Group and the National Cancer Institute of Canada. J Clin Oncol 23(28):6881–6889PubMedCrossRefGoogle Scholar
  76. 76.
    van Ruth S et al (2003) Pharmacokinetics of doxorubicin and cisplatin used in intraoperative hyperthermic intrathoracic chemotherapy after cytoreductive surgery for malignant pleural mesothelioma and pleural thymoma. Anticancer Drugs 14(1):57–65PubMedCrossRefGoogle Scholar
  77. 77.
    van Sandick JW et al (2008) Surgical treatment in the management of malignant pleural mesothelioma: a single institution’s experience. Ann Surg Oncol 15(6):1757–1764PubMedCrossRefGoogle Scholar
  78. 78.
    Vogelzang NJ et al (2003) Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 21(14):2636–2644PubMedCrossRefGoogle Scholar
  79. 79.
    Waller DA, Morritt GN, Forty J (1995) Video-assisted thoracoscopic pleurectomy in the management of malignant pleural effusion. Chest 107(5):1454–1456PubMedCrossRefGoogle Scholar
  80. 80.
    Weder W et al (2004) Neoadjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma. J Clin Oncol 22(17):3451–3457PubMedCrossRefGoogle Scholar
  81. 81.
    Weder W et al (2007) Multicenter trial of neo-adjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma. Ann Oncol 18(7):1196–1202PubMedCrossRefGoogle Scholar
  82. 82.
    Wolf AS et al (2010) The efficacy of argon beam ablation: Potential role in pleurectomy for mesothelioma (Abstract). In: The 10th international conference of the international mesothelioma interest group, Kyoto, 2010, JapanGoogle Scholar
  83. 83.
    Yajnik S et al (2003) Hemithoracic radiation after extrapleural pneumonectomy for malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys 56(5):1319–1326PubMedCrossRefGoogle Scholar
  84. 84.
    Yan TD et al (2009) Extrapleural pneumonectomy for malignant pleural mesothelioma: outcomes of treatment and prognostic factors. J Thorac Cardiovasc Surg 138(3):619–624PubMedCrossRefGoogle Scholar
  85. 85.
    Yasufuku K et al (2006) Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer. Chest 130(3):710–718PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Department of Thoracic and Cardiovascular Surgery, Unit #445The University of Texas, M.D. Anderson Cancer CenterHoustonUSA

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