Pleurectomy in Mesothelioma Treatment

Mesothelioma is an aggressive cancer of the mesothelial lining, most often of the lung and chest cavity. The cancer is not often caught until the most advanced stages because it is relatively asymptomatic and can take decades to develop. Mesothelioma is almost exclusively caused by asbestos exposure, which reached peak consumption in the United States in the 1960s and 70s. Though the cancer causes the premature death of thousands of Americans each year, there are no standardized modes of treatment.

Pleurectomy is considered a radical treatment for mesothelioma, in which the diseased mesothelial lining is removed by a thoracic or cardiothoracic surgeon. Asbestos exposure attorneys follow developments in mesothelioma treatment very closely, and consistently report on new studies conducted on the disease. A retroactive study by the Medical University of Graz Thoracic and Hyperbaric Surgery Division evaluated the survival of patients who underwent a pleurectomy.

The chief objective of a pleurectomy is to remove as much tumor as possible to enable re-expansion of the lung and prevent further effusions. Pleural effusions are a common but debilitating symptom of advanced mesothelioma, wherein excess fluid builds up and puts pressure on the lungs and chest, making it increasingly difficult to breathe. Pleurectomy relieves this pressure and provides sustaining comfort.

Pleurectomies are almost always combined with decortication, which removes any visible tumor masses growing inside the lining. Patients in the earlier stages of mesothelioma are the best candidates for pleurectomy and decortications; those in the later stages often have too extensively spread tumor growths.

Pleurectomy and decortications can provide palliative relief from symptomatic effusions, discomfort caused by tumor burden, and pain caused by invasive tumors. Operative mortality from pleurectomy/decortications is less than 2%, while mortality from extrapleural pneumonectomy has ranged from 6% to 30%. Extrapleural pneumonectomy is another, more invasive surgical treatment for mesothelioma, often conducted in those in more advanced stages.

In the University of Graz study, those patients with epitheloid type mesothelioma survived longer when treated with pleurectomy and decortication.

The preeminence of aggressive and radical surgery has been widely abandoned in favor of a multimodal therapeutic approach, which usually includes chemotherapy and radiation. Pleurectomy and decortications enable the patient to reserve physiological entities for further treatment options. This mode of treatment has a better outcome than extrapleural pneumonectomy with longer survival time when the resection was part of a multimodal approach.

Another study by University Hospital Berne investigated the feasibility of a novel approach to the treatment of malignant pleural mesothelioma by combining surgical resection with immediate postoperative intrapleural chemotherapy and subsequent systemic chemotherapy.

Patients with biopsy-proven, resectable malignant pleural mesothelioma underwent pleurectomy/decortication immediately followed by intrapleural chemotherapy with cisplatin. Systemic chemotherapy was started 3 to 5 weeks postoperatively. Patients were then monitored by serial chest and abdominal computed tomographic (CT) scans every 3 months until death or for a minimum of 18 months, whichever occurred first.

Of 36 patients entered onto the study, 28 had pleurectomy/decortication and intrapleural chemotherapy. There was one postoperative death and two episodes of grade 4 renal toxicity after intrapleural chemotherapy. The 23 patients who also had systemic chemotherapy received a median of 80% and 87% of the planned total cisplatin and mitomycin doses, respectively. No grade 3 or 4 toxicities were observed.

The overall survival rate of the 27 patients who were originally candidates for systemic chemotherapy was 68% at 1 year and 40% at 2 years, with a median survival duration of 17 months. Locoregional disease was the most common form of relapse (16 of 20 patients).

This short but aggressive combined modality regimen was generally well tolerated, but should not be used outside of a protocol setting because of the potential for serious toxicity. Overall survival was as good or better than with previously reported multimodality approaches, but other strategies are needed to improve local control.

In both studies, a prolonged survival rate was observed following pleurectomy/decortications and chemotherapy. Mesothelioma lawyers at Pintas & Mullins Law Firm highlight the importance of such studies in the advancement of mesothelioma treatment. Over 3,000 Americans die each year from the cancer, nearly all of whom were exposed to high levels of asbestos in their lifetime. If you were diagnosed with mesothelioma or any other asbestos-related disease, you have important legal rights. Contact one of our asbestos exposure attorneys today for a free legal consultation.

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