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Aydin S, Aydin SK, Yavuz H, Ergonul AG, Akcam TI, Turhan K, Cakan A, Cagirici U. Postoperative early laboratory changes and follow-up process of patients underwent hyperthermic intrathoracic chemotherapy. BMC Surg 2024; 24:267. [PMID: 39300533 DOI: 10.1186/s12893-024-02565-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND The aim of combining hyperthermic intrathoracic chemotherapy (HITHOC) with surgery is to achieve local control in patients with pleural malignancies. Liver and kidney dysfunction resulting from this procedure have been reported in the literature. The objective of the study is to examine whether the laboratory abnormalities observed during the initial period persist until day 30. METHODS The study conducted a retrospective analysis of the blood glucose levels, renal function markers, and hepatic function markers of 30 patients who underwent pleurectomy-decortication and HITHOC for pleural mesothelioma from January 2010 to April 2022. The measurements were taken in the postoperative period on the first four and 30th days. The study analyzed the initial and final laboratory results caused by the procedure. RESULTS Out of the total of 30 patients, 29, 28, 14, and 12 patients had elevated glucose levels on the first four days after the surgery, respectively. There was no association between glucose abnormalities and preoperative-postoperative diabetes mellitus. A minority of patients experienced atypical alterations in kidney and liver functions during the initial postoperative period. There was no apparent relationship between the renal and hepatic functions in the early and late periods after the surgery. CONCLUSION Although there were fluctuations in glucose levels and renal and hepatic functions in the early period after surgery, there were no persistent alterations in these parameters by day 30. Elevated glucose levels during the early period were not associated with the development of newly diagnosed diabetes mellitus after surgery. The findings of our study provide evidence that HITHOC is a favorable and well-tolerated treatment option for mesothelioma.
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Affiliation(s)
- Sercan Aydin
- Department of Thoracic Surgery, Izmir Democracy University Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Turkey.
| | - Seda Kahraman Aydin
- Department of Thoracic Surgery, Izmir Democracy University Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Turkey
| | - Hasan Yavuz
- Department of Thoracic Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Ayse Gul Ergonul
- Department of Thoracic Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Tevfik Ilker Akcam
- Department of Thoracic Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Kutsal Turhan
- Department of Thoracic Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Alpaslan Cakan
- Department of Thoracic Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Ufuk Cagirici
- Department of Thoracic Surgery, Ege University School of Medicine, Izmir, Turkey
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Lippi L, de Sire A, Aprile V, Calafiore D, Folli A, Refati F, Balduit A, Mangogna A, Ivanova M, Venetis K, Fusco N, Invernizzi M. Rehabilitation for Functioning and Quality of Life in Patients with Malignant Pleural Mesothelioma: A Scoping Review. Curr Oncol 2024; 31:4318-4337. [PMID: 39195305 DOI: 10.3390/curroncol31080322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 08/29/2024] Open
Abstract
Malignant pleural mesothelioma (MPM) represents a significant clinical challenge due to limited therapeutic options and poor prognosis. Beyond mere survivorship, setting up an effective framework to improve functioning and quality of life is an urgent need in the comprehensive management of MPM patients. Therefore, this study aims to review the current understanding of MPM sequelae and the effectiveness of rehabilitative interventions in the holistic approach to MPM. A narrative review was conducted to summarize MPM sequelae and their impact on functioning, disability, and quality of life, focusing on rehabilitation interventions in MPM management and highlighting gaps in knowledge and areas for further investigation. Our findings showed that MPM patients experience debilitating symptoms, including fatigue, dyspnea, pain, and reduced exercise tolerance, decreasing quality of life. Supportive and rehabilitative interventions, including pulmonary rehabilitation, physical exercise improvement, psychological support, pain management, and nutritional supplementation, seem promising approaches in relieving symptoms and improving quality of life but require further research. These programs emphasize the pivotal synergy among patient-tailored plans, multidisciplinary team involvement, and disease-specific focus. Despite advancements in therapeutic management, MPM remains a challenging disease with limited effective interventions that should be adapted to disease progressions. Rehabilitative strategies are essential to mitigate symptoms and improve the quality of life in MPM patients. Further research is needed to establish evidence-based guidelines for rehabilitative interventions tailored to the unique needs of MPM patients.
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Affiliation(s)
- Lorenzo Lippi
- Department of Scientific Research, Off-Campus Semmelweis University of Budapest, Campus LUdeS Lugano (CH), 1085 Budapest, Hungary
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy
| | - Vittorio Aprile
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Dario Calafiore
- Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy
| | - Arianna Folli
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", 28100 Novara, Italy
| | - Fjorelo Refati
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", 28100 Novara, Italy
| | - Andrea Balduit
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Burlo Garofolo, 34100 Trieste, Italy
| | - Alessandro Mangogna
- Institute of Pathological Anatomy, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Mariia Ivanova
- Division of Pathology, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Konstantinos Venetis
- Division of Pathology, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Nicola Fusco
- Division of Pathology, European Institute of Oncology, IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", 28100 Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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Romano G, Zirafa CC, Ceccarelli I, Elia G, Davini F, Melfi F. Update in the Treatment of Pleural Tumors: Robotic Surgery Combined with Hyperthermic Intrathoracic Chemotherapy. Cancers (Basel) 2024; 16:1691. [PMID: 38730643 PMCID: PMC11083528 DOI: 10.3390/cancers16091691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background. Intracavitary hyperthermic chemotherapy (HITHOC) remains part of the complex mosaic that is the multimodal approach for advanced stage thymoma and pleural malignancies. However, robotic pleurectomy/removal of pleural lesions in combination with intrathoracic chemotherapy is not currently being investigated. The aim of this study is to evaluate the safety of robotic pleurectomy/removal of relapses and HITHOC in patients with pleural recurrence of thymoma or MPM. (2) Methods: The data of nine consecutive patients affected by thymoma relapses or MPM who underwent robotic surgery in combination with HITHOC from February 2017 to November 2022 were collected and analyzed. Surgery performed prior to intrathoracic infusion of high-temperature chemotherapy consisted of removal of recurrences (three patients) or pleurectomy (six patients). All surgeries were performed with a four-port, fully robotic technique. (3) Results: No intraoperative complications occurred. No renal complications related to infusion were recorded. One patient, who underwent pleurectomy for MPM, had a grade II Clavien-Dindo postoperative complication. Oncological follow-up showed results in line with the literature. (4) Conclusions: With the limitation of the small number of patients, robotic surgery in combination with HITHOC seems to be safe in patients with pleural relapses of thymoma and early-stage MPM.
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Affiliation(s)
- Gaetano Romano
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (I.C.); (F.D.); (F.M.)
| | - Carmelina Cristina Zirafa
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (I.C.); (F.D.); (F.M.)
| | - Ilaria Ceccarelli
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (I.C.); (F.D.); (F.M.)
| | - Gianmarco Elia
- Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy;
| | - Federico Davini
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (I.C.); (F.D.); (F.M.)
| | - Franca Melfi
- Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy; (C.C.Z.); (I.C.); (F.D.); (F.M.)
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4
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Ambrogi MC, Aprile V, Lenzini A, Bacchin D, Mastromarino MG, Korasidis S, Lucchi M. TNM Staging System in Thymoma: A Critical Appraisal? J Clin Med 2024; 13:610. [PMID: 38276116 PMCID: PMC10817025 DOI: 10.3390/jcm13020610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Thymomas are rare tumors of the anterior mediastinum with peculiar clinical and pathological features. They have been deeply analyzed by pioneer authors, who strictly linked their name to the main pathological and staging classifications. Before the latest edition of the WHO classification of thymic epithelial tumors, the history of thymoma pathological classification inherited the name of the pathologists who systematically addressed the issue, from Levine-Rosai to Muller-Hermelink. Similarly, the thymoma staging system is intimately related to the name of two surgeons, Masaoka and Koga, who historically dealt with this disease. More recently, the traditional tumor-nodes-metastasis (TNM) system has been developed for the staging of this condition, in a rational attempt to put thymomas in conformity with the other solid tumors. The efforts of the International Thymic Malignancies Interest Group (ITMIG) and the Thymic Domain of the Staging and Prognostic Factors Committee (TD-SPFC) of the International Association for the Study of Lung Cancer (IASLC) resulted in the TNM classification of thymic tumors, which have been included in the eighth edition of the American Joint Committee on Cancer's (AJCC) Cancer Staging Manual. Herein, we report a narrative review of the evolution of the thymic epithelial tumors (TET) staging system and present a critical appraisal of the actual TNM classification compared with the historical Masaoka-Koga classification, with special focus on the proposal for the ninth edition of the TNM, expected in 2024.
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Affiliation(s)
- Marcello Carlo Ambrogi
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Vittorio Aprile
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Alessandra Lenzini
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Diana Bacchin
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Maria Giovanna Mastromarino
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
| | - Stylianos Korasidis
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
| | - Marco Lucchi
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
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Tisza A, Klikovits T, Benej M, Torok S, Szeitz B, Valko Z, Hoda MA, Hegedus B, Bonta M, Nischkauer W, Hoetzenecker K, Limbeck A, Schelch K, Laszlo V, Megyesfalvi Z, Dome B. Laser ablation-inductively coupled plasma-mass spectrometry analysis reveals differences in chemotherapeutic drug distribution in surgically resected pleural mesothelioma. Br J Clin Pharmacol 2023; 89:3364-3374. [PMID: 37272312 PMCID: PMC10952999 DOI: 10.1111/bcp.15813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
AIMS Pleural mesothelioma (PM) is a highly aggressive thoracic tumour with poor prognosis. Although reduced tissue drug accumulation is one of the key features of platinum (Pt) resistance, little is known about Pt distribution in human PM. METHODS We assessed Pt levels of blood samples and surgically resected specimens from 25 PM patients who had received neoadjuvant Pt-based chemotherapy (CHT). Pt levels and tissue distributions were measured by laser ablation-inductively coupled plasma-mass spectrometry and correlated with clinicopathological features. RESULTS In surgically resected PM specimens, mean Pt levels of nontumourous (fibrotic) areas were significantly higher (vs tumourous regions, P = 0.0031). No major heterogeneity of Pt distribution was seen within the tumourous areas. Pt levels correlated neither with the microvessel area nor with apoptosis rate in the tumourous or nontumourous regions. A significant positive correlation was found between serum and both full tissue section and tumourous area mean Pt levels (r = 0.532, P = 0.006, 95% confidence interval [95% CI] 0.161-0.771 and r = 0.415, P = 0.039, 95% CI 0.011-0.702, respectively). Furthermore, a significant negative correlation was detected between serum Pt concentrations and elapsed time from the last cycle of CHT (r = -0.474, P = 0.017, 95% CI -0.738--0.084). Serum Pt levels correlated negatively with overall survival (OS) (P = 0.029). CONCLUSIONS There are major differences in drug distribution between tumourous and nontumourous areas of PM specimens. Serum Pt levels significantly correlate with full section and tumourous area average Pt levels, elapsed time from the last CHT cycle, and OS. Further studies investigating clinicopathological factors that modulate tissue Pt concentration and distribution are warranted.
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Affiliation(s)
- Anna Tisza
- Department of Tumor BiologyNational Korányi Institute of PulmonologyBudapestHungary
- Department of Pathology and Experimental Cancer ResearchSemmelweis UniversityBudapestHungary
| | - Thomas Klikovits
- Department of Thoracic Surgery, Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Karl‐Landsteiner‐Institute for Clinical and Translational Thoracic Surgery Research, Clinic FloridsdorfViennaAustria
| | - Michal Benej
- Karl‐Landsteiner‐Institute for Clinical and Translational Thoracic Surgery Research, Clinic FloridsdorfViennaAustria
| | - Szilvia Torok
- Department of Tumor BiologyNational Korányi Institute of PulmonologyBudapestHungary
| | - Beata Szeitz
- Division of Oncology, Department of Internal Medicine and OncologySemmelweis UniversityBudapestHungary
| | - Zsuzsanna Valko
- Department of Thoracic Surgery, Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Mir Alireza Hoda
- Department of Thoracic Surgery, Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Balazs Hegedus
- Department of Thoracic Surgery, University Medicine Essen – RuhrlandklinikUniversity Duisburg‐EssenEssenGermany
- Department of Pathology, Forensic and Insurance MedicineSemmelweis UniversityBudapestHungary
| | - Maximilian Bonta
- Institute of Chemical Technologies and Analytics, Division of Instrumental Analytical ChemistryTU WienViennaAustria
| | - Winfried Nischkauer
- Institute of Chemical Technologies and Analytics, Division of Instrumental Analytical ChemistryTU WienViennaAustria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Andreas Limbeck
- Institute of Chemical Technologies and Analytics, Division of Instrumental Analytical ChemistryTU WienViennaAustria
| | - Karin Schelch
- Department of Thoracic Surgery, Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Center for Cancer ResearchMedical University of ViennaViennaAustria
| | - Viktoria Laszlo
- Department of Tumor BiologyNational Korányi Institute of PulmonologyBudapestHungary
- Department of Thoracic Surgery, Comprehensive Cancer CenterMedical University of ViennaViennaAustria
| | - Zsolt Megyesfalvi
- Department of Tumor BiologyNational Korányi Institute of PulmonologyBudapestHungary
- Department of Thoracic Surgery, Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Department of Thoracic SurgeryNational Institute of Oncology‐Semmelweis UniversityBudapestHungary
| | - Balazs Dome
- Department of Tumor BiologyNational Korányi Institute of PulmonologyBudapestHungary
- Department of Thoracic Surgery, Comprehensive Cancer CenterMedical University of ViennaViennaAustria
- Department of Thoracic SurgeryNational Institute of Oncology‐Semmelweis UniversityBudapestHungary
- Department of Translational MedicineLund UniversityLundSweden
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Miller DL, Parks CS, Ange B, Bonta IR, Rich PT. Hyperthermic intrathoracic extracorporeal chemotherapy for secondary malignant pleural disease. J Surg Oncol 2023; 128:604-611. [PMID: 37409778 DOI: 10.1002/jso.27389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES Pleural metastasis has extremely poor prognosis. Resection of pleural implants with infusion of intrathoracic hyperthermic chemotherapy may offer a survival advantage in selected patients. We evaluated the safety and efficacy of hyperthermic intrathoracic extracorporeal chemotherapy (HITEC) in patients who underwent pleurectomy/decortication (P/D) for secondary malignant pleural disease (SPD). METHODS A total of 101 patients were evaluated over 72 months, with 35 patients electing to proceed with P/D and 60 minutes of HITEC with cisplatin at 42°C. Inclusion criteria were adults 18-79 years with unilateral pleural dissemination. Exclusion criteria were patients without control of primary site, extrathoracic metastatic disease, significant comorbidities, and a history of adverse reaction to cisplatin. RESULTS Median age was 56 years (36-73); 60% were women. SPD was thymoma in 13, breast cancer in 9, lung cancer in 6, colon cancer in 2, renal cell in 2, and esophageal, anal, and thymic cancers in one each. There was no operative mortality. Postoperative complications occurred in 18 patients (51%). No patient developed renal failure. Median follow-up was 24 months (4-60). The overall survival rate was 61%; 17 patients (49%) developed recurrent disease at a median of 12 months (6-36). There were no recurrences after 36 months Eleven patients (31%) died of metastatic disease at a median of 17 months (7-25). CONCLUSIONS Surgical cytoreduction of SPD followed by HITEC with cisplatin was well tolerated. No patient developed cisplatin-related toxicities. Long-term follow-up is warranted to determine survival advantage and refinement of inclusion criteria.
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Migliore M, Fiore M, Filippini T, Tumino R, Sabbioni M, Spatola C, Polosa R, Vigneri P, Nardini M, Castorina S, Basile F, Ferrante M. Comparison of video-assisted pleurectomy/decortication surgery plus hyperthermic intrathoracic chemotherapy with VATS talc pleurodesis for the treatment of malignant pleural mesothelioma: A pilot study. Heliyon 2023; 9:e16685. [PMID: 37292347 PMCID: PMC10245266 DOI: 10.1016/j.heliyon.2023.e16685] [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: 12/29/2022] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
Hyperthermic intrathoracic chemotherapy (HITHOC) adjunct to surgery for Malignant Pleural Mesothelioma (MPM) has no definite role. The primary objective of this pilot-trial was to evaluate the feasibility for future large studies. The study design was a prospective randomized three-centric pilot trial. We recruited patients diagnosed with MPM and prospectively assigned them to two groups: Group A: Video Assisted Thoracic Surgery (VATS) talc pleurodesis or Group B: Video-assisted P/D plus HITHOC. From November-2011 to July-2017 24 males and 3 females, with a median age of 68-years were enrolled (recruitment rate 5 patients/year). Preoperative stage was I-II, and 18 had epithelioid type. 14 patients were in the Group A. Operative mortality was 0. Follow-up ranged 6-80 months. The median overall survival time started to diverge at 20 months, being 19 months (95% CI 12-25) in Group A and 28 months (95% CI 0-56) in Group B. Survival rate for the epithelioid type was 15 months (95% CI 0-34) in Group A and 45 months (95% CI 0-107) in the Group B. These findings suggest that video-assisted P/D plus HITHOC may improve survival time in MPM patients undergoing surgical treatment and support the need for a larger multicenter randomized clinical trial.
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Affiliation(s)
- Marcello Migliore
- Minimally Invasive Thoracic Surgery and New Technologies University Hospital of Catania, Department of General Surgery and Medical Specialties, University of Catania, Catania, Italy
- Thoracic Surgery and Lung Transplant, Lung Health Centre, Organ Transplant Center of Excellence (OTCoE), King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Maria Fiore
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP 7), Ragusa, Italy
| | | | | | - Riccardo Polosa
- General Medicine, Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy
| | - Paolo Vigneri
- Center of Oncology and Hematology, Department of Clinical & Experimental Medicine University of Catania, Catania, Italy
| | - Marco Nardini
- Department of Thoracic Surgery, St. James University Hospital, London, UK
| | - Sergio Castorina
- General and Thoracic Surgery, Morgagni Policlinic Hospital, Catania, Italy
| | - Francesco Basile
- General Surgery, University Hospital of Catania, Department of General Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Margherita Ferrante
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
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Guo X, Lin L, Zhu J. Immunotherapy vs. Chemotherapy in Subsequent Treatment of Malignant Pleural Mesothelioma: Which Is Better? J Clin Med 2023; 12:jcm12072531. [PMID: 37048614 PMCID: PMC10095244 DOI: 10.3390/jcm12072531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: Malignant pleural mesothelioma (MPM) is a rare but aggressive tumor arising from the pleural surface. For relapsed MPM, there is no accepted standard of- are for subsequent treatment. Thus, we aimed to compare the efficacy of chemotherapy, targeting drugs, and immune-checkpoint inhibitors (ICIs) as subsequent therapy for relapsed MPM. (2) Methods: The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched several acknowledged databases. Primary outcomes were defined as overall median progressive survival (mPFS) and median overall survival (mOS) in different treatment groups. Secondary outcomes were defined as objective response rate (ORR), the proportion of stable disease (SD), and progressive disease (PD). (3) Results: Ultimately, 43 articles were selected for the meta-analysis. According to the results of a pooled analysis of single-arm studies, ICIs showed a slight advantage in mOS, while chemotherapy showed a slight advantage in mPFS (mOS: 11.2 m vs. 10.39 m and mPFS: 4.42 m vs. 5.08 m for ICIs group and chemotherapy group, respectively). We identified only a few studies that directly compared the efficacy of ICIs with that of chemotherapy, and ICIs did not show significant benefits over chemotherapy based on mOS. (4) Conclusions: Based on current evidence, we considered that immunotherapy might not be superior to chemotherapy as a subsequent therapy for relapsed MPM. Although several studies investigated the efficacy of ICIs, targeting drugs, and chemotherapy in relapsed MPM, there was still no standard of care. Further randomized control trials with consistent criteria and outcomes are recommended to guide subsequent therapy in relapsed MPM and identify patients with certain characteristics that might benefit from such subsequent therapy.
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Liu L, Zhang T, Song X, Liao CG, Xu T, Yang Y, Zeng M, Jia J, Su H, Song Y, Min J, Zhang H, Li W, Zhang H, Zhang H. Hyperthermic intrathoracic/intraperitoneal chemotherapy versus conventional intrapleural/intraperitoneal chemotherapy for the malignant effusion: a multi-center randomized clinical trial. Int J Hyperthermia 2023; 40:2241689. [PMID: 37574198 DOI: 10.1080/02656736.2023.2241689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/26/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVE To compare the efficacy and safety of hyperthermic intrathoracic/intraperitoneal chemotherapy versus conventional intrapleural/intraperitoneal chemotherapy in the treatment of malignant pleural or peritoneal effusion. METHODS A randomized clinical trial was carried out in 8 cancer centers across China. Patients with malignant pleural or peritoneal effusion were randomly assigned to the study group or control group. Patients in the study group were treated with cisplatin-based hyperthermic intrathoracic chemotherapy (HITHOC) or hyperthermic intraperitoneal chemotherapy (HIPEC), while the control group was treated with conventional intrapleural or intraperitoneal chemotherapy using same chemotherapeutic regime as the study group. The objective response rate (ORR) was analyzed as primary outcome. Quality-of-life (QOL) score was recorded as secondary outcome using the questionnaire 30 (QLQ-C30) of the European Organization for Research and Treatment of Cancer (EORTC). The efficacy and safety of the two treatments were compared. RESULTS Total 135 patients were recruited and randomized in this study, with 67 patients in the study group and 68 patients in the control group. The ORR in the study group (80.70%) was significantly higher than that in the control group (31.03%, p < 0.001). However, neither changes of QOL scores, nor incidence rates of adverse events were significantly different between the two groups (p = 0.076 and 0.197, respectively). CONCLUSION Efficacy of HITHOC or HIPEC is superior to that of conventional modality for the treatment of malignant effusion with comparable side effects.
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Affiliation(s)
- Lili Liu
- Department of Oncology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Tao Zhang
- Department of Oncology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Xiang Song
- Department of Radiotherapy, The Second Affiliated Hospital, Shanxi Medical University, Taiyuan, China
| | - Cheng-Gong Liao
- Department of Oncology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Tengyun Xu
- Department of Oncology, The First Affiliated Hospital, China University of Science and Technology, Hefei, China
| | - Yang Yang
- The Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University and Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Ming Zeng
- Department of Oncology, The People's Hospital of Sichuan Province, Chengdu, China
| | - Junmei Jia
- Department of Oncology, The First Affiliated Hospital, Shanxi Medical University, Taiyuan, China
| | - Haichuan Su
- Department of Oncology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Yang Song
- Department of Oncology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jie Min
- Department of Oncology, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Hongmei Zhang
- Department of Oncology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Wei Li
- Cancer Center, The First Affiliated Hospital, Jilin University, Changchun, China
| | - Hongwei Zhang
- Digestive Disease Center, Wuxi Mingci Hospital, Wuxi, China
| | - Helong Zhang
- Department of Oncology, Tangdu Hospital, Air Force Medical University, Xi'an, China
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Mastromarino MG, Aprile V, Lucchi M. Editorial: Advances in malignant pleural mesothelioma: Diagnosis, treatment, and molecular mechanisms. Front Oncol 2023; 13:1158416. [PMID: 36874144 PMCID: PMC9978700 DOI: 10.3389/fonc.2023.1158416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Affiliation(s)
- Maria Giovanna Mastromarino
- Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department; Pisa University Hospital, Pisa, Italy
| | - Vittorio Aprile
- Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department; Pisa University Hospital, Pisa, Italy.,Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department; Pisa University Hospital, Pisa, Italy.,Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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