BUFFALO, NY-While a combination of pleurectomy and intracavitary
photodynamic therapy marginally improves survival rates for some
patients with malignant pleural mesothelioma, "there exists
no compelling evidence that treatment of any kind is superior
to no treatment," reported Hiroshi Takita, MD, DSc, chief
of the Department of Thoracic Surgery, Roswell Park Cancer Institute.
Dr. Takita presented his findings at the Multidisciplinary Cancer
Care in the 21st Century conference, hosted by Roswell Park Cancer
Institute and made possible through an educational grant from
Bristol-Myers Squibb Oncology.
Approximately 3,500 Americans are diagnosed annually with malignant
pleural mesothelioma-an uncommon, generally fatal thoracic cancer
associated with asbestos exposure. Twenty years to 40 years after
exposure, 5% to 7% of asbestos workers will die of this disease.
Although a simple chest x-ray will accurately diagnose malignant
pleural mesothelioma, early symptoms-localized chest pain, cough,
weight loss, fever-are vague and often ignored by the patient
until the disease becomes life-threatening. No curative or standard
therapy currently exists for this disease, and even with treatment,
death usually results within 1 year of diagnosis.
A Surgical Disease
Up to two thirds of patients with mesothelioma die of locally
advanced disease without distant metastases. "This tells
us that mesothelioma is a surgical disease," Dr. Takita said.
But while surgery alone may produce median survival rates of up
to 18 months, it still leaves much to be desired, particularly
radical pleuropneumonectomy with its high surgical mortality and
poor postoperative survival.
"The survival benefit of surgery alone is no different than
that found in patients who have nonsurgical or no treatment,"
Dr. Takita said. "Clearly, we need to ask ourselves: What
therapy should we be combining with surgery to both justify treatment
and improve long-term survival?"