Physicians Attending International Symposium Unanimously Conclude That Patients With Malignant Pleural Mesothelioma No Longer Should Be Subjected to Radical Lung-Removing Surgery (EPP)
LOS ANGELES, May 25, 2011 /PRNewswire/ -- International mesothelioma experts gathered at the 1st International Symposium on Lung-Sparing Therapies for Malignant Pleural Mesothelioma (MPM) on Saturday, May 21, 2011 in Santa Monica, CA. A wide range of medical specialists reviewed information from a variety of U.S. centers as well as from the recently concluded Mesothelioma And Radical Surgery (MARS) trial from the U.K. The results of this randomized clinical trial were presented by English surgeons, Tom Treasure and David Waller, and clearly demonstrated that radical removal of the lung (extrapleural pneumonectomy or EPP) as advocated in Boston, New York, and other selected centers in the U.S. holds no advantage over alternative, less radical, lung-sparing therapies currently offered at other centers.
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| (left - right) Mr. David Waller, MD, Mr. Tom Treasure, MD and Dr. Robert Cameron, MD |
Following completion of the day-long session, Dr. Robert B. Cameron, the Director of the UCLA Mesothelioma Research Program and the Symposium's chairman, commented that, "The information presented at this Symposium makes an incredibly strong statement that surgical removal of the lung for treatment of malignant pleural mesothelioma should no longer be performed anywhere in the world, just like it has been abandoned already in the U.K." Dr. Cameron went on to say that, "Although it's usually hard to get physicians to agree on anything, there was unanimous agreement by the end of the conference that lung-sparing pleurectomy was the preferred surgical procedure if surgery was to be used at all."
The distinguished faculty at this landmark meeting also addressed the role of cryo- and radio-frequency ablation, radiation, chemotherapy, immunotherapy, gene therapy and promising future therapies.
For further information call Clare Cameron at the Pacific Meso Center
Pacific Meso Center
310-478-4678
ccameron@phlbi.org
www.pacificmesocenter.org
www.phlbi.org
Long-term survival after lung-sparing total pleurectomy for locally advanced (International Mesothelioma Interest Group Stage T3-T4) non-sarcomatoid malignant pleural mesothelioma.
Nakas A, von Meyenfeldt E, Lau K, Muller S, Waller D. SourceDepartment of Thoracic Surgery, Glenfield Hospital, Leicester, UK.
Abstract
OBJECTIVES
There is a body of opinion that advocates extrapleural pneumonectomy (EPP) as the only radical treatment option for locally advanced (T3/T4) malignant pleural mesothelioma (MPM). We tested the hypothesis that lung-sparing total pleurectomy (LSTP) can be as effective as EPP in locally advanced MPM with reduced risk.
METHODS
We analysed prospective data on 165 patients (128 with epithelioid and 37 with biphasic MPM) with pT3 (n = 108) and pT4 (n = 57) tumours. Ninety-eight (59.4%) of the patients underwent EPP and 67 (40.6%) LSTP. We compared intergroup differences in: length of stay (LOS), post-operative complications, survival, pattern of disease progression and disease-free interval (DFI).
RESULTS
There were significantly more complications after EPP: 67 (68%) vs. 29 (43%) in LSTP, P = 0.002. Thirty-day mortality was 7% for EPP and 3% for LSTP (P = 0.31). LOS was similar (mean 19 days for EPP, 15 days for LSTP, P = 0.19). We noted only minor differences in the initial site of disease progression. In 33 (41%) of EPP patients, disease progressed locally compared with 22 (44%) after LSTP. Seventeen patients post-EPP (21%) had distal progression compared with only three (6%) post-LSTP and synchronous distal and local recurrence was similar: 15 (19%) post-EPP vs. 12% for LSTP (P = 0.11). There was no significant intergroup difference in median survival: EPP 14.7 months (SE 1.3, 95% CI 12.2-17.2) vs. LSTP 13.4 months (SE 1.9, 95% CI 9.7-17.1), P = 0.91, nor in DFI: EPP 10.7 months (SE 0.8, 95% CI 9-12) vs. LSTP 16 months (SE 1, 95% CI 9-22). In chemonaive patients (n = 124), adjuvant chemotherapy was received by significantly more patients after LSTP (32/53 LSTP vs. 26/71 EPP patients, P = 0.011). Estimated 1-5 years survival for EPP was 58, 30, 11, 9 and 6% and for LSTP 52, 28, 20, 13 and 4%.
CONCLUSIONS
In disagreement with standard opinion, we advocate LSTP as the procedure of choice in locally advanced MPM: it offers at least equally as good oncological results as EPP in this group of patients with reduced early complications. Despite a tendency for increased local recurrence in the LSTP group, overall survival is not compromised.