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Extended Pleurectomy and Decortication Surgery Worse than Just Receiving Chemotherapy

Published: September 15, 2023

Extended pleurectomy decortication surgery combined with chemotherapy is associated with worse outcomes compared to just chemotherapy alone. Researchers looked at extended pleurectomy and decortication surgery alongside chemotherapy and found that there are worse survival outcomes, a higher chance of serious adverse events, and a diminished quality of life compared to just giving patients platinum and pemetrexed chemotherapy. The information was presented at the International Association for the Study of Lung Cancer 2023 World Conference on Lung Cancer in Singapore. Mesothelioma is a rare cancer mainly linked to asbestos exposure. Once microscopic fibers are inhaled, they can become lodged in human tissue and lead to cancers like pleural, peritoneal, pericardial, and testicular mesothelioma.

The clinical trial, known as MARS 2, was conducted at The Royal Brompton Hospital in the United Kingdom. It was led by Professor Eric Lim. The team of researchers looked at the impact of extended pleurectomy and decortication combined with chemotherapy versus chemotherapy alone in patients with mesothelioma. There are multiple treatment options for mesothelioma like pleurectomy and decortication, chemotherapy, radiation, and immunotherapy. Researchers looked at pleurectomy and decortication because it has never been examined in a randomized clinical trial.

The trial had 335 participants with mesothelioma who were eligible for surgery. There were 169 randomly assigned to receive extended pleurectomy and decortication surgery while 166 patients were randomly assigned to receive platinum and pemetrexed chemotherapy. The median time that patients were followed was 22.4 months. Patients who received the surgery and chemotherapy combination had a median overall survival of 19.3 months while patients who just received chemotherapy had a median survival of 24.8 months. The hazards of the treatments were not proportional, so researchers broke outcomes into two different timeframes: randomized to 42 months and beyond 42 months. There was a 28 percent increase in the risk of death in the group who received surgery within the first 42 months, but after 42 months there was no significant difference in death outcomes.

There were significant enough disparities in progression-free survival and adverse events within the two groups. The surgery group had 3.6 times higher incidence of serious adverse events. Those who received surgery also reported poorer quality of life and wellbeing on different EORTC health-related quality of life scales. The scales included global health, physical functioning, social functioning, and role functioning. The surgery group also had worse symptom scores including pain, trouble breathing, insomnia, loss of appetite, and financial difficulties. Professor Lim concluded that patients with pleural mesothelioma should not receive extended pleurectomy and decortication surgery and that pleural mesothelioma should be classified as “unresectable.” This would allow more access to systemic treatments and could improve survival for patients with early-stage disease.

“Extended pleurectomy decortication plus chemotherapy associated with worse outcomes for mesothelioma patients” News Medical and Life Sciences (September 11, 2023) [Link]
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