Randomized controlled trials in malignant pleural mesothelioma surgery—mistakes made and lessons learned

Waller, David; Dawson, Alan G.

doi:10.21037/atm.2017.04.05

Cited by 18 publications

(13 citation statements)

References 17 publications

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“…Three centres performed approximately 90% of all radical surgeries. Post-operative mortality rates (30-days: 4.8% and 90-days: 13.4%) were comparable with those reported in the literature [23,24].…”

Section: Discussionsupporting

confidence: 88%

Real-life treatment practice for malignant pleural mesothelioma in Belgium

Rosskamp¹,

Macq²,

Nackaerts

et al. 2018

Lung Cancer

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Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer, for which treatment is often limited to palliative combination chemotherapy. Multimodality-therapy, including radical surgery, is largely restricted to clinical trials, leaving its benefit currently unclear.This study aimed to get a comprehensive view on real-world MPM treatment at the Belgian population level, to assess survival and to identify prognostic factors. Materials and MethodsThe study period covered the incidence years 2004-2012 (N=1,453). Starting from the Belgian Cancer Registry, additional information regarding patient characteristics, diagnosis and treatment was retrieved from multiple data sources.Adjusted cox proportional-hazard regression models using time-dependent covariates were performed to assess survival in relation to treatment patterns and centre volume. ResultsSixty-nine percent of patients underwent tumour-directed treatment, mostly cisplatinpemetrexed chemotherapy. Radical surgery was mainly performed in younger patients with epithelioid subtype.Centre volume, surgery and chemotherapy showed a positive relation with survival in univariable analyses, but only chemotherapy remained significantly relevant in multivariable analyses. Younger patients, females, and epithelioid subtypes also independently had a better survival. ConclusionThis large population-based study provides insights in MPM treatment practice in Belgium.Centre volume and surgery being related to survival in univariable analyses, only chemotherapy remained prognostic after adjustment.

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Section: Discussionsupporting

confidence: 88%

Real-life treatment practice for malignant pleural mesothelioma in Belgium

Rosskamp¹,

Macq²,

Nackaerts

et al. 2018

Lung Cancer

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“…Several trials to clarify this question are underway, such as the TIME2 (unblinded RCT comparing IPC to talc as the second therapeutic intervention in malignant effusion), AMPLE (multicenter, randomized study comparing IPC versus talc pleurodesis for malignant pleural effusion) and TAPP trial [openlabel controlled trial, designed to randomize 330 patients, with a confirmed malignant pleural effusion requiring intervention, to undergo either small bore (<14 Fr) Seldinger chest drain insertion followed by instillation of sterile talc (4 g), or to undergo medical thoracoscopy and simultaneous poudrage (4 g)] [19]. The question if VAT-pleurectomy/decortication [VAT-progressive disease (PD)] is more effective than continuing drainage of the effusion with an IPC for patients with entrapped lungs in MPM is currently addressed in the multicenter, randomized feasibility MesoTRAP trial [20].…”

Section: Palliative Surgerymentioning

confidence: 99%

Pleural mesothelioma: is the surgeon still there?

Opitz

Weder

2018

Annals of Oncology

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Malignant pleural mesothelioma (MPM) is a rare malignancy with some unique characteristics. Tumor biology is aggressive and prognosis is poor. Despite more knowledge on histology, tumor biology and staging, there is still a relevant discrepancy between clinical and pathologic staging resulting in difficult prediction of prognosis and treatment outcome, making treatment allocation more challenging than in most other malignancies. After years of nihilism in the late 80s, a period of activism started evaluating different treatment protocols combined with research driven mainly by academic centers; at the time, selection was based on histology and stage only. This period was important to gain knowledge about the disease. However, the interpretation of data was difficult since selection criteria and definitions varied substantially. Not surprisingly, until now there is no common agreement on best treatment even among specialists. Hence, a review of our current concepts is indicated and personalized treatment should become applicable in the future. Surgery was and still is an issue of debate. In principle, surgery is an effective approach as it allows macroscopic complete elimination of a tumor, which is relatively resistant to medical treatment. It helps to set the clock back and other therapies that have also just a limited effect can be applied sequentially before or after surgery. Furthermore, to date best long-term outcome is reported from surgical series in combination with other modalities. However, part of the community considers surgery associated with too high morbidity and mortality when balanced to the limited life expectancy. This criticism is understandable, since poor results after surgery are reported. The present article will review the indication for surgery and discuss the different procedures available for macroscopic complete resection-such as lung-preserving (extended) pleurectomy/decortication as well as extrapleural pneumonectomy to illustrate that 'The surgeon is still there!'

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“…Considering the available data regarding the surgical treatment of MPM, it might be best to consider P/D as the first surgical option for MPM, with EPP reserved for carefully selected patients. The MARS 2 trial (ClinicalTrials.gov, NCT02040272) that intended to demonstrate the safety of adding P/D to cisplatin/pemetrexed chemotherapy in resectable MPM is nearing completion [ 17 ]. The MARS 2 trial and the following phase III study will determine the role of P/D in MPM.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of the Multimodal Treatment of Malignant Pleural Mesiothelioma: The Role of Surgery

Kim

Hyun

et al. 2018

Korean J Thorac Cardiovasc Surg

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BackgroundThe treatment of malignant pleural mesothelioma (MPM) is challenging, and multimodal treatment including surgery is recommended; however, the role of surgery is debated. The treatment outcomes of MPM in Korea have not been reported. We analyzed the outcomes of MPM in the context of multimodal treatment, including surgery.MethodsThe records of 29 patients with pathologically proven MPM from April 1998 to July 2015 were retrospectively reviewed. The treatment outcomes of the surgery and non-surgery groups were compared.ResultsThe overall median survival time was 10.6 months, and the overall 3-year survival rate was 25%. No postoperative 30-day or in-hospital mortality occurred in the surgery group. Postoperative complications included tachyarrhythmia (n=4), pulmonary thromboembolism (n=1), pneumonia (n=1), chylothorax (n=1), and wound complications (n=3). The treatment outcomes between the surgery and non-surgery groups were not significantly different (3-year survival rate: 31.3% vs. 16.7%, respectively; p=0.47). In a subgroup analysis, there was no significant difference in the treatment outcomes between the extrapleural pneumonectomy group and the non-surgery group (3-year survival rate: 45.5% vs. 16.7%, respectively; p=0.23).ConclusionMultimodal treatment incorporating surgery did not show better outcomes than non-surgical treatment. A nationwide multicenter data registry and prospective randomized controlled studies are necessary to optimize the treatment of MPM.

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Randomized controlled trials in malignant pleural mesothelioma surgery—mistakes made and lessons learned

Cited by 18 publications

References 17 publications

Real-life treatment practice for malignant pleural mesothelioma in Belgium

Real-life treatment practice for malignant pleural mesothelioma in Belgium

Pleural mesothelioma: is the surgeon still there?

Outcomes of the Multimodal Treatment of Malignant Pleural Mesiothelioma: The Role of Surgery

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