The European Journal of Cardio-Thoracic Surgery has published a new results of a new clinical trial which aimed to better understand the efficacy of certain radical surgery procedures. The study compared the results of two different treatment methods for malignant mesothelioma: radical open-lung-sparing decortication and palliative surgery.
Mesothelioma is an aggressive and terminal cancer caused by exposure to asbestos fibers. The cancer can affect several areas of the body, but the most common tumor site is the pleural mesothelium, a soft, protective tissue which encases the lungs. Mesothelioma is incredibly resilient. Curative treatments, or treatments which aim to remove the tumor and destroy remaining cancer cells with chemotherapy and radiotherapy, are often ineffective. In most cases palliative surgery is performed instead, a form of surgery which aims to improve the patient’s comfort without removing the cancerous growth.
Radical open-lung-sparing decortication refers to a procedure in which the mesothelial lining and the cancerous tumor are removed completely from the lung. Chemotherapy and radiotherapy regimens follow to kill any cancer cells remaining on or around the surgery site. The surgery is invasive and recovery often proves difficult.
Palliative surgery, on the other hand, aims solely to reduce swelling and drain fluid buildup that results from the body’s reaction to the cancerous tumor. The surgery relieves pain associated with the disease but doesn’t slow the spread of the cancer which will eventually prove fatal.
The recent trial compared 13 patients who opted for radical decortication with 13 other patients, matched for similar ages, medical history, body mass index and disease progression, who opted for palliative treatment.
“Patients were matched for age, sex, histology, computed tomography (CT) stage, haematological indices, body mass index (BMI) and adjuvant chemotherapy. We compared perioperative and postoperative courses and long-term survival,” write the study’s authors.
Results demonstrated that all types of cells in the radical surgery group out-survived those in the palliative surgery group. While technically that means that the radical surgery group fared better, the study doesn’t account for the patient’s quality of life.
“Radical open-lung-sparing surgery may confer a survival advantage to patients with malignant mesothelioma who are fit to undergo radical decortication followed by chemotherapy and radiotherapy,” states the study, “trials of radical surgery versus no surgery should include lung-sparing operations.”