Pleurectomy Decortication a Wise Option for Mesothelioma

Scientists and doctors at the recently-opened Mesothelioma and Thoracic Oncology Treatment and Research Center at the University of Maryland (Baltimore) have observed that mesothelioma patients treated with a combination of surgery, photodynamic therapy, and chemotherapy have a reasonable chance of living three years or longer once the treatment is complete.

It’s a study they recently outlined in the Annals of Thoracic Surgery.

The lead author, Dr. Joseph Friedberg, was the long-time head of thoracic oncology at the Perlman Cancer Center at the University of Pennsylvania but is now Charles Reid Edwards Professor of Surgery and Head of the Division of Thoracic Surgery at the University of Maryland School of Medicine as well as Thoracic Surgeon-in-Chief of the University of Maryland Medical System.

He has become well-known for his mesothelioma research and colleagues laud this most recent study as one that could certainly assist in prolonging the lives of victims of malignant pleural mesothelioma.

In this study, the 73 patients underwent surgery to remove the cancer in their pleural region, but the diseased lung was not removed.

Friedberg notes that this technique is more difficult than removing everything but, in the long run, leaving the lung in place helps not only to extend the life of the patient but also to improve his/her quality of life after surgery.

The lung-sparing surgery is known as a radical pleurectomy decortication. It’s a complicated surgery, says Friedberg, but one that strips away only the diseased lining of the lung (the pleura), leaving the remainder of the organ in place.

This is compared to the extrapleural pneumonectomy, which removes both the lung and its lining as well as (often) parts of the abdomen and diaphragm.

That surgery requires less skill and finesse on the part of the surgeon but the patient must endure a long recovery period and deal with long-lasting difficulties caused by the absence of one lung.

Once the pleurectomy surgery on the test subjects was complete, they were treated with therapy that included a photosensitizing agent. In addition, more than 90 percent of the participants received chemotherapy after the photodynamic therapy.

But the grueling three-step process resulted in a much better outlook for all the patients.

“These are among the best results ever published for patients with an epithelial subtype of pleural mesothelioma, which accounts for about two thirds of all cases,” stated the lead author. “This is among the most virulent cancers known to man, and we have a long way to go, but it’s encouraging to have achieved results we can report in years not months even for these patients with such advanced disease.”

Specifically, overall median survival for all the patients in the study was nearly three years (35 months), a press release reports, but that figure more than doubled, to 7.3 years, for 19 of these patients, most likely because their cancer had not spread to their lymph nodes.

In addition, researchers found that overall survival rate was three times higher than disease-free survival, which is the length of time until the cancer recurs.