There has been a long-standing debate over which surgery is more effective
for treating malignant pleural mesothelioma (MPM). For many years, a majority
of surgeons believed that a radical procedure called Extrapleural Pneumonectomy
(EPP), which involves removal of the mesothelioma tumor along with the
affected lung, diaphragm and pericardium, was the preferred way of surgically
However, in recent years, many surgeons have come to the realization that
the Pleurectomy/Decortication (P/D) procedure innovated by UCLA and West
Los Angeles VA Medical Center Thoracic Surgeon
Dr. Robert Cameron, in which the tumor is removed and the patient is left with a functioning
lung, is the more effective and less risky procedure.
For the surgeons that continue to perform EPP despite the mounting studies
confirming the effectiveness of lung-sparing P/D, one of the reasons they
cite to is the purported inability to effectively deliver radiation to
the area following P/D.
The typical protocol following both EPP and P/D is to have patients undergo
a series of radiation treatments, typically 25, beginning a month or so
after the surgery. The purpose of the radiation treatments is to eradicate
the microscopic tumor cells that remain after all visible tumor is removed.
It has been the belief of EPP proponents that radiation treatments following
P/D are much less effective because of the presence of the lung and related tissues.
study published in the November edition of the international journal
Lung Cancer disproves this theory. Researchers at the Centro di Riferimento Oncologico
di Aviano in northern Italy monitored 20 patients with malignant pleural
mesothelioma who were given localized high dose radiation therapy following
P/D surgery. The patients underwent 25 radiation treatments likely over
the course of five weeks. The survival rate in the study was 70 percent
at two years and 49 percent at three years or more, with a median survival
rate of 33 months. The estimated progression-free survival rate was 68
percent at two years and 46 percent at three years.
The results of this study confirm what proponents of P/D have believed
for some time, namely that it is possible to deliver full dose radiation
following lung-sparing surgery.