Phase II Italian Researchers, Pleurectomy-Decortication Shows Favorable Survival Rate
Researchers at the University of Pisa in Italy have concluded in the February, 2007 issue of the Journal of Thoracic Oncology that pleurectomy-decortication surgery combined with chemotherapy produces a favorable survival rate for patient with malignant pleural mesothelioma.
Similar to the multi-modal treatment advocated by Dr. Robert Cameron at UCLA's David Geffen School of Medicine, the Italian researchers used pleurectomy-decortication surgery as opposed to complete removal of the lung. Pleurectomy is a procedure that carefully removes the pleural lining around the lung while sparing the lung itself. Decortication refers to cutting away as much of the tumor as possible.
The surgical alternative for most patients with pleural mesothelioma is complete removal of the lung, which leaves many patients with substantial impairments post-surgery. The Italian researchers acknowledged that treatment ranges from doing nothing other than trying to reduce the pain, to aggressive anticancer therapy including major surgery. There is no consensus on the optimal therapeutic strategy.
In 1999, the researchers began a phase II study to investigate four-modality treatment of advanced stage malignant pleural mesothelioma. From 1999 to 2004, 49 patients with stage II-III mesothelioma underwent four-modality treatment with intrapleural preoperative interleukin, pleurectomy / decortication, intrapleural postoperative epidoxorubicin, interleukin-2, adjuvant radiotherapy, systemic chemotherapy (cisplatin, gemcitabine) and long-term subcutaneous interleukin-2.
After a median follow-up of 59 months, 13 patients are still alive and the median actuarial survival is 26 months (31 and 21 months for stages II and III, respectively). The 2- and 5-year actuarial survival rates were 60.2% and 23.3%, respectively. Baseline Eastern Cooperative Oncology Group performance status significantly influenced survival time. The study concluded that the four-modality treatment adopted for advanced-stage mesothelioma was feasible, well tolerated by most of the patients, and produced a favorable median survival. This treatment approach warrants further investigation.
*** POSTED APRIL 15, 2007 ***