Complete surgical removal of mesothelioma tissue significantly prolongs survival in those with the cancer, according to researchers who reviewed a number of studies on this treatment approach.
The longer survival occurred whether doctors performed either of the two operations commonly used to remove the cancerous tissue, researchers said.
Complete surgical removal led to particularly higher survival rates when patients were treated with a combination of therapies: surgery, radiation, and chemotherapy. Sometimes surgeons cannot remove the whole tumor during surgery.
Complete surgical removal of cancer tissue is known as macroscopic complete resection, or MCR. The two operations used to achieve it are extended pleurectomy and decortication, or EPD, and extra pleural pneumonectomy, EPP.
The study, “Malignant pleural mesothelioma: key determinants in tailoring the right treatment for the right patient,” was published in the Journal of Thoracic Disease.
Surgeons consider advanced stages of mesothelioma inoperable, and this has often meant that chemotherapy was the only alternative.
Multiple studies have found that a combination of surgery, chemo and radiation, an approach called cytoreductive surgery-based multimodality treatment, or MMT, can double or even triple patients’ survival times. But doctors have used it only with a subset of mesothelioma patients.
Cytoreductive surgery refers to a particular kind of approach to removing an entire tumor, and in mesothelioma patients the options are either EPD or EPP.
Researchers analyzed studies to determine whether removing all tumor tissue prolonged patients’ lives, and which of the two approaches — EPD or EPP — was more effective.
Four clinical trials showed that patients who had surgeons remove all of their mesothelioma tissue lived longer.
In a study of 90 mesothelioma patients treated with EPD, researchers concluded that this approach was effective and safe.
In addition, EPD correlated with a higher survival rate for node-negative patients, even those in advanced stages of mesothelioma. Node-negative patients’ cancer has not spread to their lymph nodes.
Three other studies on EPD surgery showed similar results.
The researchers noted consistent results on complete removal of tissue and on the effectiveness of EPD and EPP from study to study.
For example, patients with one of three variations of mesothelioma — epithelioid — and patients whose cancer had not spread to lymph nodes tended to do better after EPD or EPP surgery than other patients. This means surgeons should consider this subset of patients for MMT, the team said.
The researchers also noted that patients who completed the entire MMT protocol lived longer than those who didn’t, suggesting that sticking with the protocol is key to prolonging survival.
Another finding was that using heated chemotherapy as part of the surgery benefited patients who had not received radiation as well as patients whose cancer had spread to their lymph nodes. It was also safe and well-tolerated.
Finally, the researchers concluded that complete removal of a tumor is a necessary component of MMT because patients who have MCR, either by EPD or EPP, survive longer than those who don’t.
The team said EPD is better for lower morbidity — or less severe symptoms — and is associated with lower mortality than EPP, but EPP is better for patients with a high tumor burden.
The bottom line is it is necessary for surgeons to carefully evaluate patients to choose the right surgical approach for each, the researchers concluded.