17 July 2024
Patients with pleural mesothelioma who undergo a combination of surgery and chemotherapy have worse outcomes than patients who have chemotherapy alone, according to data from a recent clinical trial.
Led by Professor Eric Lim, consultant thoracic surgeon at Royal Brompton and Harefield Hospitals, the UK wide multi-centre trial looked at patients with pleural mesothelioma, a type of cancer that affects the lining of the chest.
Mesothelioma, chemotherapy and surgery
Over 30,000 people around the world are diagnosed with pleural mesothelioma every year. It is most commonly caused by asbestos and usually has a poor prognosis.
Alongside chemotherapy, most national and international guidelines suggest the option of radical surgery in an attempt to improve survival of malignant pleural mesothelioma.
Extended pleurectomy decortication (EPD) is an operation which involves removal of the lung pleura (lining), part of the covering of the heart (pericardium), and diaphragm, if it is affected by the disease.
Despite widespread recommendation in guidelines, there have been no randomised evidence on whether surgery improves survival for patients.
The trial and results
Professor Lim and his research team undertook a randomised clinical trial to compare the clinical effectiveness, safety, quality of life, and cost-effectiveness of chemotherapy and surgery versus chemotherapy alone.
335 patients from across 26 UK hospitals were randomly assigned to receive either chemotherapy and surgery or chemotherapy only.
Results from trial showed that at 2 years the surgery and chemotherapy group lived an average of 1.9 months shorter than the chemotherapy alone group. The surgery group also had increased incidence of cardiac and respiratory disorders, infection and additional surgical or medical procedures compared to the chemotherapy only group. In addition, serious complications were much higher, and the quality of life was poorer in those who received surgery.
Professor Lim said:
"The UK mesothelioma investigators have successfully completed a difficult trial that answers a question posed for over 70 years that radical surgery for mesothelioma is associated with worse survival, more complications and poorer quality of life.
“Clinicians should reconsider the concept of ‘resectable’ disease as no trial to date has demonstrated any benefit with radical surgery, as many effective systemic treatments are not licenced for patients in whom the disease is considered suitable for surgery.”
The trial was coordinated by the Bristol Trials Centre and funded by the National Institute for Health and Care Research (NIHR).
Results from the study were published in the Lancet Respiratory Medicine.
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