Patients diagnosed with the worst cases of pleural mesothelioma could benefit the most from the aggressive surgery they often are denied, according to one recent study.
The findings have raised questions about the restrictive surgery selection process at many specialty centers handling mesothelioma, the rare and aggressive cancer caused by asbestos exposure.
“In some cases, patients are not being offered the aggressive surgery that could help their quality of life,” lead author Dr. Wickii Vigneswaran, mesothelioma specialist and chief of thoracic surgery at the Loyola University Medical Center, told Asbestos.com. “Our findings showed that this subgroup of patients could be helped with surgery.”
The World Journal of Surgery published the results of the 2017 study, which was conducted by doctors and researchers at Loyola and the University of Chicago Medical Center.
“The findings kind of surprised us,” Vigneswaran said. “This needs to be considered when it comes to offering surgical treatment. These patients can benefit.”
Sicker Patients Improved the Most
The study was based on 114 patients who underwent pleurectomy/decortication (P/D) surgery in Chicago from 2008 to 2015. They were given health assessments prior to surgery and again at the different intervals of 1, 4-5, 7-8 and 10-11 months after surgery.
Researchers found the sickest patients at baseline, which are those with larger tumor volume and nonepithelial histology (usually not surgical candidates), showed more improvement to quality of life after surgery than the healthier patients.
Patients who started with a good performance status, epithelioid histology and smaller tumor volume (often deemed prime surgical candidates) did not show as much improvement after the operation.
Sicker patients typically are excluded from aggressive surgical options because of the mortality and morbidity risks, along with a quality of life concern after undergoing such an extensive procedure. Many thoracic surgeons have become increasingly selective in recommending mesothelioma patients for surgery.
Less than one-third of all pleural mesothelioma patients undergo aggressive surgery.
Quality of Life vs. Quantity of Life
The P/D surgery, which is not as radical as the extrapleural pneumonectomy, involves removing the lining surrounding the lungs, parts of the diaphragm or the entire organ, and any tissue in the thoracic cavity where cancerous tumors are found.
Overall median survival in the study group was 15.2 months, but it differed upon the tumor volume and histology. Survival was longer for those with epithelioid histology and lower tumor volume at baseline. The higher tumor volume at baseline was consistent with shorter survival time.
“The quality of life was much improved [for those with higher tumor volume], even when the quantity of life was not,” Vigneswaran said. “That could justify taking on the surgical treatment.”
According to study results, those with the higher tumor volume and nonepithelial subtype also showed a quicker quality of life improvement than the healthier group after surgery.
“The larger-volume group experienced significantly less deterioration in physical, role and social functioning as well as significantly less fatigue, pain and dyspnea when compared to the small volume group,” the authors wrote.
Vigneswaran performed each of the study surgeries at the University of Chicago before joining Loyola in January 2016 to build a new mesothelioma program that he believes can be one of the country’s best.
“Patients who may be excluded by many from surgery because of limited improvement in survival, can benefit greatly in their quality of life following P/D surgery,” he wrote in the study. “P/D extends the life in patients who had favorable characteristics, while also improving quality of life for patients with unfavorable characteristics.”