Study Debates Aggressive Treatments for Patients

The April 2012 issue of the Journal of Thoracic Oncology included a study that juxtaposed aggressive surgical methods in the treatment of malignant pleural mesothelioma (or MPM). Extrapleural pnemonectomy, or EPP, and pleurectomy/decortication, or P/D, are two surgical methods that often accompany chemotherapy and radiation treatments in what is known as a multimodal approach to the treatment of mesothelioma. Multimodal incorporates a variety of therapies and treatments, including alternative and complementary therapies as well as standard medical treatments, and is widely accepted as the most promising form of care for those diagnosed with mesothelioma. The surgical component of mesothelioma treatment is largely divided into two main approaches, which remain controversial as to which method is superior. An EPP is an extensive and aggressive surgery involving the removal of the entire diseased lung, the pleura (or lining of the lung), as well as part of the pericardium (covering of the heart), and part of the diaphragm. The less extensive surgery of the two, a P/D, involves the removal of part of the lining of the lungs, part (but not all) of the lung, and potentially part of the diaphragm and/or membrane surrounding the heart. The previously mentioned study in the Journal of Thoracic Oncology, a publication from the International Association for the Study of Lung Cancer, concluded that recent analysis shows the P/D method held better results for patients. The authors of the study proposed that “P/D become the standard surgical procedure offered as part of multimodal therapy in malignant pleural mesothelioma.” Prior to this study, EPP was considered the standard of care for mesothelioma patients; however, this and other research is replacing EPP with P/D. According to the study, “EPP resulted in higher mortality and morbidity than P/D and P/D resulted in significantly better survival rates…” An editorial in the same issue of the Journal of Thoracic Oncology and written by Dr. Michael Weyant, thoracic surgeon and assistant professor at the University of Colorado, stated that “the results of the current study by Lang-Lazdunksi et al provide additional data that should lead us to consider P/D in all trials of treatment for MPM.” However, he also noted that, “it is too early based on this data to completely abandon EPP altogether as there may be patient subsets where the potential reward outweighs the risk of the procedure.” As outlined in the study’s abstract, the research spanned eight years from January 2004 to June 2011, with a total of 22 patients undergoing EPP surgery while 5 underwent P/Ds. The two groups were autonomous in that there were no obvious differences in age, gender, histology, pathologic stage, and nodal status between them. Survival rates for the group undergoing P/D rather than EPP surgery were significantly better. Statistically speaking, the median survival rate was 23 months vs. 12.8 months, the two-year survival rate was 49 percent vs. 18.2 percent, and the five-year survival rate was 30.1 percent vs. 9 percent for P/D and EPP respectively. As studies such as this one become more prevalent, the hope remains that safer, more effective treatments for mesothelioma will also increase. References:
  • Weyant, Michael. "Is it Time to Consider Pleurectomy and Decortication as the Only Surgical Treatment for Malignant Pleural Mesothelioma?" Journal of Thoracic Oncology. 7.4 (2012): 629-630. Print.
  • Lang-Lazdunksi, et al. "Pleurectomy/Decortication is Superior to Extrapleural Pnemonectomy in the Multi Modality Management of Patients with Malignant Pleural Mesothelioma." Journal of Thoracic Oncology. 7.4 (2012): 737-743. Print.
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