1
|
Bellini A, Mazzarra S, Sterrantino S, Argnani D, Stella F. Second Surgery for Recurrent Malignant Pleural Mesothelioma after Multimodality Treatment: A Systematic Review. J Clin Med 2022; 11:jcm11123340. [PMID: 35743417 PMCID: PMC9225173 DOI: 10.3390/jcm11123340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive asbestos-related tumour with poor prognosis. To date, a multimodality treatment, including chemotherapy and surgery, with or without radiotherapy, is the gold standard therapy for selected patients with epithelioid and early-stage MPM. In this setting, the goal of surgery is to achieve the macroscopic complete resection, obtained by either extrapleural pneumonectomy or pleurectomy/decortication. Failure, in local and/or distant sites, is one of the major concerns; in fact, there has been no established treatment for the recurrence of MPM after the multimodal approach, and the role of surgery in this context is still controversial. By using electronic databases, studies that included recurrent MPM patients who underwent a second surgery were identified. The endpoints included were: a pattern of recurrence, post-recurrence survival (PRS), and the type of second surgery. When available, factors predicting better PRS and perioperative mortality and morbidity were collected. This systematic review offers an overview of the results that are currently obtained in patients undergoing a second surgery for relapsed MPM, with the aim to provide a comprehensive view on this subject that explores if a second surgery leads to an improvement in survival.
Collapse
Affiliation(s)
- Alice Bellini
- Department of Surgery, Division of Thoracic Surgery, G.B. Morgagni—L. Pierantoni Hospital, Via Carlo Forlanini n.34, 47121 Forlì, Italy; (S.M.); (S.S.); (D.A.); (F.S.)
- Correspondence: ; Tel.: +39-0543-735650
| | - Sara Mazzarra
- Department of Surgery, Division of Thoracic Surgery, G.B. Morgagni—L. Pierantoni Hospital, Via Carlo Forlanini n.34, 47121 Forlì, Italy; (S.M.); (S.S.); (D.A.); (F.S.)
| | - Sara Sterrantino
- Department of Surgery, Division of Thoracic Surgery, G.B. Morgagni—L. Pierantoni Hospital, Via Carlo Forlanini n.34, 47121 Forlì, Italy; (S.M.); (S.S.); (D.A.); (F.S.)
| | - Desideria Argnani
- Department of Surgery, Division of Thoracic Surgery, G.B. Morgagni—L. Pierantoni Hospital, Via Carlo Forlanini n.34, 47121 Forlì, Italy; (S.M.); (S.S.); (D.A.); (F.S.)
| | - Franco Stella
- Department of Surgery, Division of Thoracic Surgery, G.B. Morgagni—L. Pierantoni Hospital, Via Carlo Forlanini n.34, 47121 Forlì, Italy; (S.M.); (S.S.); (D.A.); (F.S.)
- Department of Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, Division of Thoracic Surgery, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, via Carlo Forlanini n. 34, 47121 Forlì, Italy
| |
Collapse
|
2
|
Pinton G, Wang Z, Balzano C, Missaglia S, Tavian D, Boldorini R, Fennell DA, Griffin M, Moro L. CDKN2A Determines Mesothelioma Cell Fate to EZH2 Inhibition. Front Oncol 2021; 11:678447. [PMID: 34277422 PMCID: PMC8281343 DOI: 10.3389/fonc.2021.678447] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/14/2021] [Indexed: 12/13/2022] Open
Abstract
Malignant pleural mesothelioma is an aggressive cancer, heterogeneous in its presentation and behaviour. Despite an increasing knowledge about molecular markers and their diagnostic and prognostic value, they are not used as much as they might be for treatment allocation. It has been recently reported that mesothelioma cells that lack BAP1 (BRCA1 Associated Protein) are sensitive to inhibition of the EZH2 (Enhancer of Zeste Homolog 2) histone methyltransferase. Since we observed strong H3K27me3 (histone H3 lysine 27 trimetylation) immunoreactivity in BAP1 wild-type mesothelioma biopsies, we decided to characterize in vitro the response/resistance of BAP1 wild-type mesothelioma cells to the EZH2 selective inhibitor, EPZ-6438. Here we demonstrate that BAP1 wild-type mesothelioma cells were rendered sensitive to EPZ-6438 upon SIRT1 (Sirtuin 1) silencing/inhibition or when cultured as multicellular spheroids, in which SIRT1 expression was lower compared to cells grown in monolayers. Notably, treatment of spheroids with EPZ-6438 abolished H3K27me3 and induced the expression of CDKN2A (Cyclin-Dependent Kinase Inhibitor 2A), causing cell growth arrest. EPZ-6438 treatment also resulted in a rapid and sustained induction of the genes encoding HIF2α (Hypoxia Inducible Factor 2α), TG2 (Transglutaminase 2) and IL-6 (Interleukin 6). Loss of CDKN2 is a common event in mesothelioma. CDKN2A silencing in combination with EPZ-6438 treatment induced apoptotic death in mesothelioma spheroids. In a CDKN2A wild-type setting apoptosis was induced by combining EPZ-6438 with 1-155, a TG2 selective and irreversible inhibitor. In conclusion, our data suggests that the expression of CDKN2A predicts cell fate in response to EZH2 inhibition and could potentially stratify tumors likely to undergo apoptosis.
Collapse
Affiliation(s)
- Giulia Pinton
- Department of Pharmaceutical Sciences, University of Piemonte Orientale (UPO), Novara, Italy,*Correspondence: Laura Moro, ; Giulia Pinton,
| | - Zhuo Wang
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Cecilia Balzano
- Department of Pharmaceutical Sciences, University of Piemonte Orientale (UPO), Novara, Italy
| | - Sara Missaglia
- Laboratory of Cellular Biochemistry and Molecular Biology, Centro di Ricerca in Biochimica E Nutrizione dello Sport (CRIBENS), Catholic University of the Sacred Heart, Milan, Italy
| | - Daniela Tavian
- Laboratory of Cellular Biochemistry and Molecular Biology, Centro di Ricerca in Biochimica E Nutrizione dello Sport (CRIBENS), Catholic University of the Sacred Heart, Milan, Italy
| | - Renzo Boldorini
- Department of Health Science, University of Piemonte Orientale (UPO), Novara, Italy
| | - Dean A. Fennell
- Leicester Cancer Research Centre, University of Leicester, Leicester, United Kingdom
| | - Martin Griffin
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Laura Moro
- Department of Pharmaceutical Sciences, University of Piemonte Orientale (UPO), Novara, Italy,*Correspondence: Laura Moro, ; Giulia Pinton,
| |
Collapse
|
3
|
Surgical Management and Reconstruction of Diaphragm, Pericardium and Chest Wall in Mesothelioma Surgery: A Review. J Clin Med 2021; 10:jcm10112330. [PMID: 34073544 PMCID: PMC8197912 DOI: 10.3390/jcm10112330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022] Open
Abstract
Mesothelioma is an aggressive disease arising from parietal pleura. Surgery is a valuable option in the frame of a multimodality treatment. Several surgical approaches have been standardized with the aim of a macroscopic complete resection; these often require homolateral diaphragm and pericardial resection and reconstruction. Extrapleural pneumonectomy (EPP) and extended pleurectomy decortication (EPD) have been recognized as radical surgical procedures. Nevertheless, both operations are technically challenging and associated with a significant rate of peri-operative morbidity and non-negligible mortality. The diaphragmatic and pericardial reconstruction technique is mandatory to avoid respiratory impairment and to reduce post-operative complications like gastric and cardiac herniation. Moreover, in the case of localized chest wall recurrence, surgery might be considered a valuable therapeutical option for highly selected and fit patients. All the technical aspects of the resection and reconstruction of the diaphragm, pericardium, and chest wall are described as well as the possible use of new minimally invasive techniques. In addition, the choice of different prosthetic materials, considering the most recent innovations in the field, are discussed.
Collapse
|
4
|
Bellini A, Dell’Amore A, Terzi S, Zambello G, Zuin A, Pasello G, Calabrese F, Schiavon M, Rea F. Relapse Patterns and Tailored Treatment Strategies for Malignant Pleural Mesothelioma Recurrence after Multimodality Therapy. J Clin Med 2021; 10:jcm10051134. [PMID: 33800433 PMCID: PMC7962831 DOI: 10.3390/jcm10051134] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 12/31/2022] Open
Abstract
To date, there have been no established therapies for recurrent malignant pleural mesothelioma (MPM) after multimodality treatment. Aims of this retrospective study are to analyze the recurrence pattern, its treatment and to identify the predictors of best oncological outcomes for relapsed MPM, comparing extrapleural pneumonectomy (EPP) vs. pleurectomy/decortication (PD). Study population: 94 patients with recurrence of MPM after multimodality treatment underwent macroscopic complete resection (52.1% with EPP and 47.9% with PD) between July 1994 and February 2020. Distant spread was the most frequent pattern of recurrence (71.3%), mostly in the EPP group, while the PD group showed a higher local-only failure rate. Post-recurrence treatment was administered in 86.2%, whereas best supportive care was administered in 13.8%. Median post-recurrence survival (PRS) was 12 months (EPP 14 vs. PD 8 months, p = 0.4338). At multivariate analysis, predictors of best PRS were epithelial histology (p = 0.026, HR 0.491, IC95% 0.263–0.916), local failure (p = 0.027, HR 0.707, IC95% 0.521–0.961), DFS ≥ 12 months (p = 0.006, HR 0.298, IC95% 0.137–0.812) and post-recurrence medical treatment (p = 0.046, HR 0.101, IC95% 0.897–0.936). The type of surgical intervention seems not to influence the PRS if patients are fit enough to face post-recurrence treatments. In patients with a prolonged disease-free interval, in the case of recurrence the most appropriate treatment seems to be the systemic medical therapy, even in the case of local-only relapse.
Collapse
Affiliation(s)
- Alice Bellini
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (A.B.); (S.T.); (G.Z.); (A.Z.); (M.S.); (F.R.)
| | - Andrea Dell’Amore
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (A.B.); (S.T.); (G.Z.); (A.Z.); (M.S.); (F.R.)
- Correspondence: ; Tel.: +49-821-22-42; Fax: +49-821-22-20
| | - Stefano Terzi
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (A.B.); (S.T.); (G.Z.); (A.Z.); (M.S.); (F.R.)
| | - Giovanni Zambello
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (A.B.); (S.T.); (G.Z.); (A.Z.); (M.S.); (F.R.)
| | - Andrea Zuin
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (A.B.); (S.T.); (G.Z.); (A.Z.); (M.S.); (F.R.)
| | - Giulia Pasello
- Medical Oncology, Veneto Institute of Oncology IOV IRCCS, 35128 Padova, Italy;
| | - Fiorella Calabrese
- Pathology Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy;
| | - Marco Schiavon
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (A.B.); (S.T.); (G.Z.); (A.Z.); (M.S.); (F.R.)
| | - Federico Rea
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (A.B.); (S.T.); (G.Z.); (A.Z.); (M.S.); (F.R.)
| |
Collapse
|
5
|
Elsayed HH, Hassaballa AS, Ahmed TA, Sharkawy HY. Recurrence of mesothelioma after a macroscopic complete resection procedure: is a second radical surgery justified? Interact Cardiovasc Thorac Surg 2021; 32:761-763. [PMID: 33496324 DOI: 10.1093/icvts/ivaa338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/17/2020] [Accepted: 12/12/2020] [Indexed: 11/15/2022] Open
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was: In patients with mesothelioma who develop a local recurrence after macroscopic complete resection (MCR) surgery, does performing a second radical surgery lead to improvement in survival? A total of 2076 papers were identified using the reported search, of which 3 represented the best evidence to answer the clinical question. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. The 2 largest studies included 16 patients each who underwent a second surgery for radical resection of recurrence after MCR for mesothelioma. One study (with 16 chest wall resections) had no in-hospital mortality, whereas the other study showed 2/16 (12.5%) patients dying in the hospital, both of whom had a contralateral pleurectomy. One study correlated the median survival after the second surgery with the time to recurrence and epithelioid pathology. The other study showed better post-recurrence survival after a second surgery, with patients having a significantly longer median post-recurrence survival (16 months) compared with those who received other types of second-line therapy (9 months) and those who received no therapy at all (2 months) (P < 0.0005), although selection bias is a possibility. The last study included 8 patients who underwent a second surgery for radical intent after MCR for mesothelioma. The median time to recurrence was 29 months and the survival after second surgery was 14.5 months with no correlation to disease-free interval (expected due to the small number of patients). In patients presenting with recurrence of mesothelioma after an MCR procedure, radical surgery to resect the recurrent tumour could have a role in improvement of survival in selected patients. Positive prognostic factors include epithelioid pathology and a longer disease-free interval after the first procedure.
Collapse
Affiliation(s)
- Hany Hasan Elsayed
- Thoracic Surgery Department, Ain Shams University Hospital, Cairo, Egypt
| | | | - Taha Aly Ahmed
- Cardio-Thoracic Surgery Department, Ain Shams University Hospital, Cairo, Egypt
| | | |
Collapse
|
6
|
A case of surgically treated bilateral metachronous malignant pleural mesothelioma. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 27:121-124. [PMID: 32082839 DOI: 10.5606/tgkdc.dergisi.2019.16162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/03/2018] [Indexed: 11/21/2022]
Abstract
In this article, we present a 59-year-old male patient who was admitted to our hospital with right pleural effusion and right-sided chest pain and diagnosed as malignant pleural mesothelioma with thoracentesis and pleural biopsy. After the patient was determined to be operable, right parietal pleurectomy + pericardial resection + diaphragmatic resection were performed and four cycles of cisplatin and pemetrexed combination as adjuvant treatment were added. The patient was followed-up without any problem for three and a half years. At this time, left-sided chest pain and leftsided effusion were noticed. Tumor was negative in thoracentesis and pleural biopsy. Then, video-assisted thoracoscopic surgery was applied, which resulted in Stage 1a malignant pleural mesothelioma. Thoracoscopic parietal pleurectomy was performed with success. Four cycles of pemetrexed single-agent therapy was performed as an adjuvant treatment. The patient died of chronic obstructive pulmonary disease and heart failure in 57th month of the first and 21st month of the second operation while he was tumor free. To the best of our knowledge, this case is the first operated bilateral metachronous primary malignant pleural mesothelioma in the literature.
Collapse
|
7
|
Bueno R, Opitz I. Surgery in Malignant Pleural Mesothelioma. J Thorac Oncol 2018; 13:1638-1654. [DOI: 10.1016/j.jtho.2018.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 01/05/2023]
|
8
|
Kang SR, Bok JS, Lee GD, Choi SH, Kim HR, Kim DK, Park SI, Kim YH. Surgical Options for Malignant Mesothelioma: A Single-Center Experience. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:195-201. [PMID: 29854664 PMCID: PMC5973216 DOI: 10.5090/kjtcs.2018.51.3.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/13/2017] [Accepted: 12/28/2017] [Indexed: 12/04/2022]
Abstract
Background We investigated the surgical outcomes of patients who underwent therapeutic surgery for malignant pleural mesothelioma (MPM) at a single center. Methods A retrospective review of 21 patients who underwent therapeutic surgery for MPM from January 2001 to June 2015 was conducted to assess their outcomes. The patients’ characteristics and postoperative course, including complications, mortality, overall survival, and recurrence-free survival, were analyzed. Results Of the 21 patients who underwent therapeutic surgery, 15 (71.4%) underwent extrapleural pneumonectomy, 2 pleurectomy (9.5%), and 4 excision (19.1 %). The median age was 57 years (range, 32–79 years) and 15 were men (71.4%). The mean hospital stay was 16 days (range, 1–63 days). Median survival was 14.3 months. The survival rate was 54.2%, 35.6%, and 21.3% at 1, 3, and 5 years, respectively. In patients’ postoperative course, heart failure was a major complication, occurring in 3 patients (14.3%). The in-hospital mortality rate was 2 of 21 (9.5%) due to a case of severe pneumonia and a case of acute heart failure. Conclusion A fair 5-year survival rate of 21.3% was observed after surgical treatment. Heart failure was a major complication in our cohort. Various surgical methods can be utilized with MPM, each with its own benefits, taking into consideration the severity of the disease and the comorbidities of the patient. Patients with local recurrence may be candidates for surgical intervention, with possible satisfying results.
Collapse
Affiliation(s)
- Seung Ri Kang
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jin San Bok
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Se Hoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| |
Collapse
|
9
|
Oehl K, Vrugt B, Opitz I, Meerang M. Heterogeneity in Malignant Pleural Mesothelioma. Int J Mol Sci 2018; 19:ijms19061603. [PMID: 29848954 PMCID: PMC6032160 DOI: 10.3390/ijms19061603] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 12/13/2022] Open
Abstract
Despite advances in malignant pleural mesothelioma therapy, life expectancy of affected patients remains short. The limited efficiency of treatment options is mainly caused by inter- and intra-tumor heterogeneity of mesotheliomas. This diversity can be observed at the morphological and molecular levels. Molecular analyses reveal a high heterogeneity (i) between patients; (ii) within different areas of a given tumor in terms of different clonal compositions; and (iii) during treatment over time. The aim of the present review is to highlight this diversity and its therapeutic implications.
Collapse
Affiliation(s)
- Kathrin Oehl
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zürich, Switzerland.
- Institute of Pathology and Molecular Pathology, University Hospital Zürich, 8091 Zürich, Switzerland.
| | - Bart Vrugt
- Institute of Pathology and Molecular Pathology, University Hospital Zürich, 8091 Zürich, Switzerland.
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zürich, Switzerland.
| | - Mayura Meerang
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zürich, Switzerland.
| |
Collapse
|
10
|
Abtin F, Quirk MT, Suh RD, Hsu W, Han SX, Kim GHJ, Genshaft S, Sandberg JK, Olevsky O, Cameron RB. Percutaneous Cryoablation for the Treatment of Recurrent Malignant Pleural Mesothelioma: Safety, Early-Term Efficacy, and Predictors of Local Recurrence. J Vasc Interv Radiol 2016; 28:213-221. [PMID: 27979596 DOI: 10.1016/j.jvir.2016.09.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 09/20/2016] [Accepted: 09/23/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To determine safety and early-term efficacy of CT-guided cryoablation for treatment of recurrent mesothelioma and assess risk factors for local recurrence. MATERIALS AND METHODS During the period 2008-2012, 24 patients underwent 110 cryoablations for recurrent mesothelioma tumors in 89 sessions. Median patient age was 69 years (range, 48-82 y). Median tumor size was 30 mm (range, 9-113 mm). Complications were graded using Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0). Recurrence was diagnosed on CT or positron emission tomography/CT by increasing size, nodular enhancement, or hypermetabolic activity and analyzed using the Kaplan-Meier method. Cox proportional hazards model was used to determine covariates associated with local tumor recurrence. RESULTS Median duration of follow-up was 14.5 months. Complications occurred in 8 of 110 cryoablations (7.3%). All but 1 complication were graded CTCAE v4.0 1 or 2. No procedure-related deaths occurred. Freedom from local recurrence was observed in 100% of cases at 30 days, 92.5% at 6 months, 90.8% at 1 year, 87.3% at 2 years, and 73.7% at 3 years. Tumor recurrence was diagnosed 4.5-24.5 months after cryoablation (mean 5.7 months). Risk of tumor recurrence was associated with a smaller ablative margin from the edge of tumor to iceball ablation margin (multivariate hazard ratio 0.68, CI 0.48-0.95, P = .024). CONCLUSIONS CT-guided cryoablation is safe for local control of recurrent mesothelioma, with a low rate of complications and promising early-term efficacy. A smaller ablative margin may predispose to tumor recurrence.
Collapse
Affiliation(s)
- Fereidoun Abtin
- Division of Thoracic Radiology, University of California, Los Angeles, Los Angeles, California.
| | - Matthew T Quirk
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California
| | - Robert D Suh
- Division of Thoracic Radiology, University of California, Los Angeles, Los Angeles, California
| | - William Hsu
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California
| | - Simon X Han
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California
| | - Grace-Hyun J Kim
- Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California
| | - Scott Genshaft
- Division of Thoracic Radiology, University of California, Los Angeles, Los Angeles, California
| | - Jesse K Sandberg
- Mallinckrodt Institut of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Olga Olevsky
- Division of Hematology and Oncology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Robert B Cameron
- Division of Thoracic Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
11
|
Bertoglio P, Fanucchi O, Ricciardi S, Chella A, Lucchi M, Mussi A. Chest wall resection for mesothelioma recurrence after surgery. Asian Cardiovasc Thorac Ann 2016; 24:893-895. [PMID: 27926466 DOI: 10.1177/0218492316674861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Malignant pleural mesothelioma is an aggressive and usually fatal disease, and its optimal management is still under debate. Surgery for recurrent malignant mesothelioma has been reported rarely in highly selected cases. We report a case of chest wall resection for local recurrence of epithelioid mesothelioma 3 years after cytoreductive surgery. Our patient experienced a 6-month disease-free survival after redo surgery, with complete resolution of his chest pain and discomfort.
Collapse
Affiliation(s)
- Pietro Bertoglio
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Olivia Fanucchi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Sara Ricciardi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Antonio Chella
- Division of Pneumonology, University Hospital of Pisa, Pisa, Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Alfredo Mussi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| |
Collapse
|
12
|
Halezeroğlu S, Migliore M. Management of recurrence after initial surgery for malignant pleural mesothelioma: a mini-review. Future Oncol 2016; 11:23-7. [PMID: 26638919 DOI: 10.2217/fon.15.312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Recurrence after surgery in the multimodality therapy for malignant pleural mesothelioma is a common problem. As the majority of patients experience not only local but also distant metastases, a systemic treatment strategy in addition to local control measures remains necessary. Nevertheless, none of the chemotherapy regimens have achieved clinical success. Local management modalities such as stereotaxic treatments, cryoablation and redo surgery on the other hand have promising results, but provide palliative outcomes.
Collapse
Affiliation(s)
- Semih Halezeroğlu
- Thoracic Surgery Department, Faculty of Medicine, Acıbadem University, Acıbadem Maslak Hospital, Buyukdere Cad, 34457 Istanbul, Turkey
| | - Marcello Migliore
- Academic Thoracic Surgery, Department of Surgery & Medical Specialties, University of Catania, 95124 Catania, Italy
| |
Collapse
|
13
|
Bertoglio P, Waller DA. The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence. Expert Rev Respir Med 2016; 10:663-72. [PMID: 27015594 DOI: 10.1586/17476348.2016.1171147] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Surgery has a key role at different points in the management of Malignant Pleural Mesothelioma. Diagnosis with video assisted thoracoscopy offers excellent sensitivity and specificity and a direct view of the pleural cavity to verify the extent of the tumor. Nodal involvement can be assessed by mediastinoscopy and either talc pleurodesis or partial pleurectomy can be used for symptom control in advanced stage disease. Extra Pleural Pneumonectomy (EPP) and Extended Pleurectomy Decortication (EPD) are used to prolong survival although the benefit of radical surgery has not has been fully clarified; EPP failed to show its benefit in the MARS trial and EPD is currently under investigation in the MARS2 trial. More randomized prospective trial data are needed to fully understand the role of radical surgery in the treatment of pleural mesothelioma.
Collapse
Affiliation(s)
- Pietro Bertoglio
- a Division of Thoracic Surgery , University Hospital of Pisa , Pisa, Italy.,b Division of Thoracic Surgery , Glenfield Hospital , Leicester , UK
| | - David A Waller
- b Division of Thoracic Surgery , Glenfield Hospital , Leicester , UK
| |
Collapse
|
14
|
Kostron A, Friess M, Crameri O, Inci I, Schneiter D, Hillinger S, Stahel R, Weder W, Opitz I. Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma. Eur J Cardiothorac Surg 2015; 49:1516-23. [PMID: 26590183 DOI: 10.1093/ejcts/ezv398] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/01/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To analyse the relapse pattern and influence of second-line treatment after recurrence of malignant pleural mesothelioma (MPM) in patients who had previously undergone multimodality treatment. METHODS Between September 1999 and December 2013, 136 patients underwent macroscopic complete resection (MCR) by extrapleural pneumonectomy after induction chemotherapy for MPM. We analysed 106 patients who presented with recurrent disease until October 2014. Data were retrieved from our mesothelioma database, with additional information regarding precise localization gathered by reviewing the imaging and medical records. RESULTS The overall recurrence rate was 78% (106/136 patients). The median freedom from recurrence was 9 months after surgery [95% confidence interval (95% CI) 7-10]. Local recurrence only was observed in 33 patients (31%), distant metastases only in 27 patients (26%) and simultaneous distant and local recurrence in 46 patients (43%). Local recurrence was observed significantly less frequently in patients having received adjuvant radiotherapy (19 vs 47%, P = 0.003), but there was no significant impact on overall survival (OS) [radiation: 22 months (95% CI 19-24); no-radiation: 23 months (95% CI 18-27), P = 0.6]. The median OS was 22 months (95% CI 21-24), median post-recurrence survival (PRS) was 7 months (95% CI 5-9) and patients with local recurrence only survived significantly longer (12 months, 95% CI 8-16) compared with patients with distant recurrence only (5 months, 95% CI 2-8) or distant plus local relapse (6 months, 95% CI 3-9; P = 0.04). A total of 78 patients received a second-line therapy after tumour recurrence: chemotherapy (n = 48), local radiotherapy (n = 9), surgery (n = 10) or a combination thereof (n = 11). Patients undergoing second-line treatment survived significantly longer compared with patients not receiving therapy (P < 0.0005). The median PRS after surgery was significantly longer than that of patients receiving chemo-, radio- or chemo-radiotherapy (P = 0.04). CONCLUSIONS Local recurrence of MPM remains the most frequent type of relapse even after multimodality treatment including MCR. In the present cohort, active treatment seems beneficial to the patient since surgical excision of local tumour relapse has good long-term outcome in selected patients. Thus, second-line treatment may prolong PRS; however, these results need to be confirmed in a prospective manner.
Collapse
Affiliation(s)
- Arthur Kostron
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martina Friess
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ornella Crameri
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ilhan Inci
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Sven Hillinger
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Rolf Stahel
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
15
|
Leuzzi G, Melis E, Forcella D, Facciolo F. Iterative surgery for recurrent malignant pleural mesothelioma in long-term survivor. ANZ J Surg 2015; 87:946-947. [PMID: 25879924 DOI: 10.1111/ans.13072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Giovanni Leuzzi
- Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy
| | - Enrico Melis
- Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy
| | - Daniele Forcella
- Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy
| | - Francesco Facciolo
- Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy
| |
Collapse
|
16
|
Clinical indications and results after chest wall resection for recurrent mesothelioma. J Thorac Cardiovasc Surg 2013; 146:1373-9; discussion 1379-80. [PMID: 24113019 DOI: 10.1016/j.jtcvs.2013.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 05/24/2013] [Accepted: 07/03/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The ipsilateral hemithorax is the most common site of recurrence after surgical resection for malignant pleural mesothelioma. Salvage treatment has generally been ineffective. We reviewed the outcomes after resection of isolated ipsilateral chest recurrence after cytoreductive surgery in patients with malignant pleural mesothelioma. METHODS Patients with malignant pleural mesothelioma who underwent initial surgical resection at our institution from 1988 to 2011 and were subsequently treated for localized recurrence with an additional chest resection were identified and their data retrospectively reviewed. RESULTS A total of 1142 patients underwent either extrapleural pneumonectomy (n = 794) or pleurectomy/decortication (n = 348). Of the patients who returned for follow-up, 47 (4.1%) had chest wall recurrence amenable to resection. The location of recurrence was predominantly incisional (49%) and/or costophrenic (38%). The median time to recurrence after either extrapleural pneumonectomy or pleurectomy/decortication was 16.1 months (range, 2.7-58.2). No 30-day mortality was found for chest wall resection, and the median length of stay in the hospital was 3 days (range, 0-12). The median overall survival duration after chest wall resection correlated positively with the time to recurrence (epithelial: median, 8.9, 17.2, and 35.8 months for a time to recurrence of <12, 12 to <24, and ≥24 months, respectively; biphasic: median, 2.7 and 15.9 months for a time to recurrence of <10 and ≥10 months, respectively). CONCLUSIONS Chest wall resection is a safe and effective therapeutic option in the management of localized chest wall recurrence of malignant pleural mesothelioma. The time to recurrence appears to be predictive of the expected survival benefit in both epithelial and biphasic malignant pleural mesothelioma.
Collapse
|
17
|
Rice D. Invited commentary. Ann Thorac Surg 2010; 89:210-1. [PMID: 20103237 DOI: 10.1016/j.athoracsur.2009.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 10/22/2009] [Accepted: 11/02/2009] [Indexed: 10/20/2022]
Affiliation(s)
- David Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Box 445, Houston, TX 77030-4009, USA.
| |
Collapse
|