Multimodality Attacks Against Mesothelioma Yield Better Results

Researchers in Europe have found that malignant pleural mesothelioma attacked with a combination of radical surgery, povidone-iodine hyperthermic pleural lavage, preventive radiotherapy, and systemic chemotherapy can be a safe and effective strategy for extending survival.

Among patients treated with these four modalities all at once, median survival was 32 months. Notably, an average of 23 percent of the patients in the study lived at least five years after treatment.

Patients with the epithelioid type of mesothelioma fared even better with this approach. They achieved a median survival of 35 months — and nearly 31 percent of them survived beyond the five-year mark.

Mesothelioma Treatment Strategy Components

The surgery that all of the patients in this study underwent was pleurectomy/decortication — commonly abbreviated as P/D.

The P/D procedure entails removing the mesothelioma-stippled tissue membrane that forms the lining between the exterior of the lungs and interior of the chest wall.

A P/D is different from an extrapleural pneumonectomy. That’s where, in addition to removing the lining, they also take out one of the lungs and perhaps the diaphragm and pericardium.

Also investigated in this study was hyperthermic pleural lavage. This procedure is performed to clean out the pleural space by flooding it with chemotherapy agents — in this instance povidone-iodine.

Prophylactic chest wall radiotherapy — another form of treatment administered to the study subjects — is intended to kill mesothelioma cells by precision targeting them with sufficient doses of radiation.

The patients in this study also received systemic chemotherapy. This means they were given mesothelioma-killing agents designed to roam through the bloodstream and travel to all parts of the body in search of mesothelioma cells that might have wandered away from the surgery site.

More Than 100 Mesothelioma Patients Studied

Lead author Loïc Lang-Lazdunski, M.D., Ph.D., from The Lister Hospital in London, explained that the study involved retrospectively evaluating patients who underwent a P/D with povidone-iodine-based hyperthermic pleural lavage, prophylactic chest wall radiotherapy dosed at 21 Gy, and systemic chemotherapy in either pill or intravenous form between January 2004 and December 2013.

The researchers indicated that all of the patients received radiotherapy after the surgery had been performed, while the systemic chemotherapy was administered either preoperatively or as an adjuvant therapy.

A total of 102 patients were included in the study and 73 of them had the epithelioid type of mesothelioma, according to the researchers. Nearly 80 percent of the subjects were men. The median age of the patients was 64.

The researchers reported that the patients were seen by doctors 30 days after treatment and then monitored every six months thereafter.

PET-CT scanning was performed at those follow-ups to see whether mesothelioma tumors had started up again or were spreading.

The researchers reported these findings in the Journal of Thoracic and Cardiovascular Surgery. The title of the study is “Pleurectomy/Decortication, Hyperthermic Pleural Lavage with Povidone-Iodine, Prophylactic Radiotherapy, and Systemic Chemotherapy in Patients with Malignant Pleural Mesothelioma: A 10-Year Experience.”

Most of the researchers were from British institutions, but at least one hailed from San Luigi Hospital in Rorino, Italy.