Some Older Mesothelioma Patients May Be OK for Lung-Sparing EPD Surgery

Extended pleurectomy decortication (EPD) is an aggressive enough type of mesothelioma surgery that it is thought to be always contraindicated for elderly mesothelioma patients.

However, a group of researchers from the University of Leicester Hospitals in England now believe that a mesothelioma patient’s advanced age should not by itself automatically exclude him or her from consideration as a candidate for EPD.

The researchers suggest that additional aspects of an elderly mesothelioma patient’s condition should be evaluated before ruling out EPD. It might turn out that he or she is actually an appropriate candidate for the surgery, they contend.

According to the researchers, one additional aspect that should be evaluated is nodal disease status. Another is whether the elderly mesothelioma patient appears capable of tolerating adjuvant chemotherapy.

Mesothelioma Research Shared at ESMO

The University of Leicester researchers aired their views on EPD for elderly mesothelioma patients at the ESMO Conference held in Vienna, Austria.

ESMO stands for European Society for Medical Oncology. It has more than 13,000 oncologists and allied clinicians from around the world, representing at least 130 countries.

Each year, ESMO conducts an annual meeting in a European capital city or other large metropolis to exchange ideas and details of their latest findings.

All cancers are discussed at these events, and mesothelioma receives considerable attention.

The University of Leicester researchers titled their ESMO presentation “Extended Pleurectomy Decortication for Malignant Pleural Mesothelioma in the Elderly — The Need for an Inclusive Yet Selective Approach.”

The researchers decided to explore the matter of EPD for the elderly because, in the United Kingdom, 72 is the median age of men and women at the time they are diagnosed with malignant pleural mesothelioma.

EPD Data for Almost 300 Mesothelioma Patients

EPD is known as lung-sparing surgery. It is sparing in the sense that the lung itself is not removed — just the lining over the lung.

EPD surgery is performed in two steps. First, the surgeon takes out the mesothelioma-blanketed lining surrounding one of the lung lobes. This is the pleurectomy part of the operation.

Second, the surgeon finds and removes mesothelioma tumors lurking on the wall of your chest cavity. This is the decortication part of the procedure. Most mesothelioma doctors and clinics give chemotherapy and radiation therapy after EPD.

To conduct their study, the University of Leicester researchers reviewed data from every patient who received an EPD at one of the school’s hospitals between the years 1999 and 2015. There were 282 such patients.

Then they divided that cohort into two age categories — those at and above 70 and those under 70. They ended up identifying 79 patients age 70 and above. Those 79 patients accounted for 28 percent of the cohort.

The researchers discovered a complete absence of differences in demographic or pathological characteristics between the two groups.

“A higher proportion of patients in the elderly group required intensive care post-operatively and developed atrial fibrillation,” they revealed.

The researchers also found no difference in median length of hospital stay between the older and younger patients.

However, their review of the records did reveal that elderly patients were less likely to receive adjuvant chemotherapy. Even so, “overall survival was similar; 10.5 months vs. 13.0 months,” the researchers said.

One particularly notable difference was the survival rates of elderly patients with sarcomatoid and biphasic mesothelioma tumors versus those with the epithelioid type.

Those with the nonepithelioid mesothelioma tumors were found to have significantly decreased survival rates compared to those with the same tumor types in younger EPD patients, the researchers observed.