Systematic review of quality of life following pleurectomy decortication and extrapleural pneumonectomy for malignant pleural mesothelioma

Introduction. Malignant pleural mesothelioma (MPM) is an aggressive cancer arising from pleural mesothelium. Surgery aims to either cure the disease or control the symptoms. Two surgical procedures exist: extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). In this systematic review we assess current evidence on safety and efficacy of surgery. Methods. Five electronic databases were reviewed from January 1990 to January 2013. Studies were selected according to a predefined protocol. Primary endpoint was overall survival. Secondary endpoints included quality of life, disease-free survival, disease recurrence, morbidity, and length of hospital stay. Results. Sixteen studies were included. Median survival ranged from 8.1 to 32 months for P/D and from 6.9 to 46.9 months for EPP. Perioperative mortality was 0%–9.8% and 3.2%–12.5%, respectively. Perioperative morbidity was 5.9%–55% for P/D and 10%–82.6% for EPP. Average length of stay was 7 days for P/D and 9 days for EPP. Conclusion. Current evidence cannot definitively answer which procedure (EPP or P/D) is more beneficial in terms of survival and operative risks. This systematic review suggests that surgery in the context of trimodality therapy offers acceptable perioperative outcomes and long-term survival. Centres specialising in MPM management have better results.

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Quality of Life Is Not Deteriorated After Extrapleural Pneumonectomy vs. (Extended) Pleurectomy/Decortication in Patients With Malignant Pleural Mesothelioma

Frontiers in Surgery ◽

10.3389/fsurg.2021.766033 ◽

2021 ◽

Vol 8 ◽

Author(s):

Olivia Lauk ◽

Miriam Patella ◽

Thomas Neuer ◽

Ilhan Inci ◽

Walter Weder ◽

...

Keyword(s):

Quality Of Life ◽

Lung Function ◽

Malignant Pleural Mesothelioma ◽

Forced Expiratory Volume ◽

Extrapleural Pneumonectomy ◽

General Tendency ◽

High Morbidity ◽

Pleural Mesothelioma ◽

Sf 36

Background: Extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM) is highly abandoned due to high morbidity and mortality rates and impaired quality of life (QoL). However, there are still rare indications for this intervention. The aim of this longitudinal prospective study was to monitor QoL and lung function in patients undergoing EPP and compare the outcomes with extended pleurectomy/decortication [(E)PD].Methods: Between June 2013 and June 2017, 42 patients underwent induction chemotherapy followed by either EPP (n = 7) or (E)PD (n = 35). All patients filled out the EORTC QLC-C15-PAL, –LC13, and SF-36 self-rating questionnaires pre-operatively, 6 weeks and 4 months after the operation. Additionally, lung function was measured pre-operatively and 4 months post-operatively.Results: We observed no significant differences in all QoL categories (general global health, pain, and dyspnea) between both surgical procedures, over the whole observation period. Moreover, a general tendency toward restoration of the pre-operative QoL status was documented at 4 months after the both operations. Forced expiratory volume in 1 s (FEV1) showed a significant decrease after surgery in both the groups [EPP group p = 0.06 and (E)PD group p < 0.001]; also, the forced volume vital capacity (FVC) significantly decreased (EPP group p = 0.046 P/D group <0.001). Diffusion capacity did not show significant changes.Conclusion: According to these results, QoL is no longer severely impaired after EPP compared with EPD, and therefore should not be used as an argument against EPP in principle. However, indication has to be carefully evaluated for each patient.

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Should Lung-Sparing Surgery Be the Standard Procedure for Malignant Pleural Mesothelioma?

Journal of Clinical Medicine ◽

10.3390/jcm9072153 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2153

Author(s):

Yoshinobu Ichiki ◽

Hidenori Goto ◽

Takashi Fukuyama ◽

Kozo Nakanishi

Keyword(s):

Systematic Review ◽

Malignant Pleural Mesothelioma ◽

Controlled Trial ◽

Standard Procedure ◽

Extrapleural Pneumonectomy ◽

Pleural Mesothelioma ◽

Systematic Review Methods ◽

Prospective Randomized Controlled Trial ◽

Long Time ◽

Related Mortality

Background: Surgical procedures for malignant pleural mesothelioma (MPM) include extrapleural pneumonectomy (EPP), extended pleurectomy/decortication (P/D) and P/D. EPP has been applied to MPM for a long time, but the postoperative status is extremely poor due to the loss of one whole lung. We compared the mortality, morbidity and median survival time (MST) of lung-sparing surgery (extended P/D or P/D) and lung-sacrificing surgery (EPP) for MPM by performing a systematic review. Methods: We extracted the number of events and patients from the literature identified in electronic databases. Ultimately, 15 reports were selected, and 2674 MPM patients, including 1434 patients undergoing EPP and 1240 patients undergoing extended P/D or P/D, were analyzed. Results: Our systematic review showed that lung-sparing surgery was significantly superior to lung-sacrificing surgery in both the surgical-related mortality (extended P/D vs. EPP: 3.19% vs. 7.65%, p < 0.01; P/D vs. EPP: 1.85% vs. 7.34%, p < 0.01) and morbidity (extended P/D vs. EPP: 35.7% vs. 60.0%, p < 0.01; P/D vs. EPP: 9.52% vs. 20.89%, p < 0.01). Lung-sparing surgery was not inferior to EPP in terms of MST. Conclusion: Although no prospective randomized controlled trial has been conducted, it may be time to change the standard surgical method for MPM from lung-sacrificing surgery to lung-sparing surgery.

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Evaluation of quality of life in survivors with malignant pleural mesothelioma in Japan

Annals of Oncology ◽

10.1093/annonc/mdx389.007 ◽

2017 ◽

Vol 28 ◽

pp. v571

Author(s):

I. Oze ◽

Y. Nagamatsu ◽

K. Aoe ◽

K. Hotta ◽

K. Kato ◽

...

Keyword(s):

Quality Of Life ◽

Malignant Pleural Mesothelioma ◽

Pleural Mesothelioma

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Early specialist palliative care on quality of life for malignant pleural mesothelioma: a randomised controlled trial

Thorax ◽

10.1136/thoraxjnl-2018-212380 ◽

2019 ◽

Vol 74 (4) ◽

pp. 354-361 ◽

Cited By ~ 7

Author(s):

Fraser Brims ◽

Samal Gunatilake ◽

Iain Lawrie ◽

Laura Marshall ◽

Carole Fogg ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Malignant Pleural Mesothelioma ◽

Controlled Trial ◽

Mean Difference ◽

Pleural Mesothelioma ◽

Life Questionnaire ◽

Specialist Palliative Care ◽

European Organization

PurposeMalignant pleural mesothelioma (MPM) has a high symptom burden and poor survival. Evidence from other cancer types suggests some benefit in health-related quality of life (HRQoL) with early specialist palliative care (SPC) integrated with oncological services, but the certainty of evidence is low.MethodsWe performed a multicentre, randomised, parallel group controlled trial comparing early referral to SPC versus standard care across 19 hospital sites in the UK and one large site in Western Australia. Participants had newly diagnosed MPM; main carers were additionally recruited. Intervention: review by SPC within 3 weeks of allocation and every 4 weeks throughout the study. HRQoL was assessed at baseline and every 4 weeks with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30. Primary outcome: change in EORTC C30 Global Health Status 12 weeks after randomisation.ResultsBetween April 2014 and October 2016, 174 participants were randomised. There was no significant between group difference in HRQoL score at 12 weeks (mean difference 1.8 (95% CI −4.9 to 8.5; p=0.59)). HRQoL did not differ at 24 weeks (mean difference −2.0 (95% CI −8.6 to 4.6; p=0.54)). There was no difference in depression/anxiety scores at 12 weeks or 24 weeks. In carers, there was no difference in HRQoL or mood at 12 weeks or 24 weeks, although there was a consistent preference for care, favouring the intervention arm.ConclusionThere is no role for routine referral to SPC soon after diagnosis of MPM for patients who are cared for in centres with good access to SPC when required.Trial registration numberISRCTN18955704.

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Phase II Study of Vinorelbine in Patients With Malignant Pleural Mesothelioma

Journal of Clinical Oncology ◽

10.1200/jco.2000.18.23.3912 ◽

2000 ◽

Vol 18 (23) ◽

pp. 3912-3917 ◽

Cited By ~ 149

Author(s):

Jeremy P. C. Steele ◽

Jonathan Shamash ◽

Marie T. Evans ◽

Nicole H. Gower ◽

Marc D. Tischkowitz ◽

...

Keyword(s):

Quality Of Life ◽

Malignant Pleural Mesothelioma ◽

Stage Iv ◽

Staging System ◽

Median Number ◽

Response To Treatment ◽

Pleural Mesothelioma ◽

Stage Iv Disease ◽

New Guidelines

PURPOSE: To evaluate the response rate and impact on quality of life of vinorelbine given as cycles of 30 mg/m2 weekly for 6 weeks to patients with malignant pleural mesothelioma. PATIENTS AND METHODS: Twenty-nine patients with histologically proven malignant pleural mesothelioma were enrolled (26 male patients and three female patients; median age, 58 years [range, 29 to 77 years]). Seventeen patients had epithelioid tumors, two had sarcomatoid tumors, and 10 had biphasic tumors. The International Mesothelioma Interest Group staging system was used: one patient had stage Ib disease, 10 had stage II disease, eight had stage III disease, and 10 had stage IV disease. Patients were treated with weekly injections of vinorelbine 30 mg/m2. A cycle consisted of six weekly injections. The new guidelines to evaluate the response to treatment in solid tumors were used. Responses were measured by spiral computed tomography scan. RESULTS: All twenty-nine patients had measurable disease and were assessed for response. There were seven partial responses (24% [95% confidence interval, 10% to 44%]), 16 patients had stable disease (55%), and six patients had disease progression on therapy (21%). The median number of vinorelbine injections was 12 (range, 2 to 30). Quality-of-life analyses showed a benefit for vinorelbine therapy. CONCLUSION: Vinorelbine shows promise in the palliation of patients with malignant pleural mesothelioma. The relatively low toxicity of the drug suggests that trials of vinorelbine in combination with other agents should be feasible.

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