Researchers at the University of Leicester Hospitals analysed the efficacy in elderly patients of extended pleurectomy decortication (EPD), the preferred surgical procedure to treat malignant pleural mesothelioma, and determined that advanced age should not be a sole criteria against treatment. Rather, a fuller assessment of health and fitness for adjuvant chemotherapy should be given elderly mesothelioma patients before EPD.
The conclusions of this retrospective review study were presented at the 2016 European Lung Cancer Conference in an abstract — “Extended pleurectomy decortication for malignant pleural mesothelioma in the elderly – the need for an inclusive yet selective approach” — available on the conference’s website.
In the United Kingdom, the median age of patients at the time of diagnosis of malignant pleural mesothelioma is 72. EPD is an aggressive surgical procedure where the lining surrounding one lung is removed, followed by the meticulous removal of any tumor mass growing in the chest cavity. This method has been preferred over extrapleural pneumonectomy for the treatment of pleural mesothelioma, as it requires stricter selection criteria — namely, good overall health. Evidence has shown that EPD is feasible in the elderly, but there is a continuing debate over its efficacy in older and more fragile patients.
Researchers conducted a review of data available on patients from 1999 to 2015 undergoing EPD. They evaluated clinical, pathological, outcome, and survival data from patients 70 years and older, compared with similar data from those younger than 70. In total, 79 of the 282 patients evaluated were age 70 or older, with no pathological or demographic differences between the two age groups.
The study revealed that more patients in the older group required intensive care post-operation than those in younger group, 16.8% vs. 5.4%, respectively. No significant differences were observed in length of hospital stay, and in hospital or 90-day mortality. Elderly patients were less likely to receive adjuvant chemotherapy, but the overall survival was similar between the two groups. Age was not a significant prognostic factor, while lack of adjuvant therapy and pre-operative anemia remained poor prognostic factors.
“Whilst age in isolation should not be an exclusion criteria for EPD for mesothelioma, in the elderly a more rigorous preoperative evaluation of nodal disease and an additional assessment of fitness for adjuvant chemotherapy, or the consideration of neoadjuvant therapy are recommended,” the researchers concluded in their conference abstract.