There is no long-term survival advantage to the more-complex, video-assisted thoracoscopic partial pleurectomy (VATPP), but it can offer a significant quality-of-life improvement over the less-invasive talc pleurodesis, according to a recent study of mesothelioma patients in the United Kingdom.
Both can alleviate fluid buildup between the lungs and the thin lining surrounding them, a common problem with pleural mesothelioma, creating a debate over which procedure is more appropriate.
The study showed the talc pleurodesis (which contains a solution of hydrated magnesium silicate and varying amounts of calcium, aluminum, and iron) will reduce the hospital stay, the occurrence of complications and costs, along with providing similar survival rates. But patients who underwent the more invasive VATPP reported a much better quality of life at both the six and 12-month survival marks.
“It was important to do this study because it will help patients make an informed decision,” Robert Rintoul, FRCP, Ph.D., respiratory physician at Papworth Hospital in Cambridge, told Asbestos.com. “I think it also will give doctors the added encouragement to do the partial pleurectomy.”
The study included 175 patients with mesothelioma in 12 different hospitals who were randomly assigned to one of the two procedures. There were 88 who underwent talc pleurodesis and 87 who had the VATPP.
Procedures Seek Same Goal
Both procedures are done to eliminate the chest pain and shortness of breath caused by the fluid buildup. The pleurodesis involves first draining the excess fluid, then sealing the space between the visceral and parietal linings of the lungs. The VATPP also involves draining the fluid, then removing a portion of the lining around the lung.
The study originally was designed to compare the survival time and costs of the two procedures, but the quality-of-life issue emerged as a secondary but equally important result.
“We found that the pleurectomy did offer some very real advantages,” Rintoul said. “I think further work is required, in more detail, to determine exactly why there was that quality of life advantage.”
The results were published last month in The Lancet, a British medical journal.
The one-year survival rate in the VATPP group was 52 percent, compared to 58 percent in the talc pleurodesis group. Surgical complications were at 31 percent for the VATPP group and only 14 percent in the talc group.
Median hospital stay was seven days for the VATPP group and three days for the talc pleurodesis group. The VATPP group also reported more air leaks in the lungs and other respiratory complications, compared to the talc group.
“That was not surprising because you’re comparing a surgical procedure with a non-surgical procedure,” Rintoul said. “On one level, this is a negative study with no difference between the two. But on the secondary endpoints of this study, the pleurectomy offers some obvious advantage.”
Significant Difference in Quality of Life
Patients in the VATPP group reported a lower quality-of-life score than the talc group at the one month mark, slightly higher quality of life at the three-month mark, but significantly better scores than the talc group at both six months and 12 months.
Rintoul, the lead author of the study, is the lead clinician for thoracic oncology at Papworth Hospital. He has done extensive research involving mesothelioma, also serving as chief investigator for MesoBanK, a national bioresource involving tissue banking.
“We’re making progress [with mesothelioma], but it’s slow,” he said. “There has been a slight increase in survival times, but it’s only in a matter of months. The survival times haven’t increased that much, but we’re seeing a better quality of life for these patients than we did 5-10 years ago.”