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 treating
MPM. 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.
A
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.
Related
Links:
- Lung-Saving P/D vs. Radical EPP
- Debunking the Myths about P/D
- Surgical Choices: Pleurectomy with Decortication
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