medwireNews: Salvage chest wall resection could lengthen survival in patients with isolated chest wall recurrence of malignant pleural mesothelioma (MPM), research indicates.
MPM is an aggressive malignancy with a poor prognosis and few effective treatment options, the researchers note. But in their study, 47 patients who underwent chest wall resection for recurrence a median of 16.1 months after initial cytoreductive surgery, the median overall survival was favorable, at 44.9 months.
Survival was greatest in patients with prolonged time to recurrence and those with the epithelial cell type.
“[O]ur results have indicated that for select patients with isolated chest wall recurrence of MPM, salvage [chest wall resection] (performed with an intent to cure) is an effective strategy,” say the researchers David Sugarbaker (Harvard Medical School, Boston, Massachusetts, USA) and colleagues.
The overall study population included 1142 patients who underwent extrapleural pneumonectomy or pleurectomy/decortication. Chest wall recurrence amenable to resection occurred in 47 patients, predominantly in the original thoracotomy incision or in the costophrenic region.
Most of these patients (68%) had epithelial histology and their time to recurrence was significantly longer than the remaining patients with biphasic histology, at a median of 23.4 months versus 11.2 months. In the former group, younger age was also associated with an increased time to recurrence. Survival following chest wall resection was also longer in patients with epithelial histology, at a median of 20.4 months versus 7.4 months for those with biphasic histology.
In both groups, survival correlated with time to recurrence. Among those with epithelial histology, the average duration of survival was 8.9 months for those whose chest wall recurrence occurred within 12 months, 17.2 months for those with recurrence at 12 to 23 months, and a considerable 35.8 months for those with recurrence at 24 months or beyond.
For those with biphasic histology, survival was an additional 15.9 months after chest wall resection for those with recurrence after at least 10 months, but only 2.7 months for those whose time to recurrence was less than 10 months.
“Thus, this latter group of patients might be better served by palliation or salvage modalities such as chemotherapy or radiotherapy or both,” the researchers suggest in The Journal of Thoracic and Cardiovascular Surgery.
But for patients with the epithelial cell type, in particular, they conclude: “It is appropriate to consider curative [chest wall resection] as standalone therapy or in conjunction with other adjuvant modalities in the management of localized ipsilateral chest recurrence for patients with a good performance status and for whom the anticipated surgical morbidity is minimal.”
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