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Malignant Pleural Mesothelioma

Overview

Malignant mesothelioma is a malignant tumour involving the pleura (lining of lung), induced by asbestos exposure in most cases. There are more than 2,000 new cases diagnosed each year in Britain. The median survival for patients with mesothelioma is thought to be around 12 months. Recent reports show that with an aggressive approach called multimodality therapy up to 45% of patients can survive for five years or more.

Diagnosis of Malignant Pleural Mesothelioma

The diagnosis of of Malignant Pleural Mesothelioma is sometimes obvious in view of a chest CT. However, other pleural cancers can mimic mesothelioma and the diagnosis has to be established by analysing some pleural tissue. In less than 10% of patients, the diagnosis will be made on pleural fluid aspirated through a simple needle. Most patients with this condition now benefit from a VATS pleural biopsy to establish the diagnosis and a VATS talc pleurodesis to prevent the re-accumulation of fluid around the lung. When fluid is absent, an open pleural biopsy is performed by the surgeon under general anaesthetic. When there is a big bulk of tumour, tissue can be obtained through a special biopsy needle under computed tomography (CT) guidance.

Treatment of Malignant Pleural Mesothelioma

The treatment is based on chemotherapy and occasionally radiotherapy for most patients diagnosed with malignant pleural mesothelioma. Chemotherapy involves three-weekly outpatient visits where drugs are injected intravenously over a few hours. Depending on the tolerance and response to treatment, the number of injections (cycles) may vary from two to more than six

For patients with early stage mesothelioma and a good general condition, multimodality therapy is considered. Multimodality therapy includes chemotherapy, radical surgery aiming at removing all the tumour and radiotherapy. Extrapleural pneumonectomy (EPP) is a major operation consisting in the removal of the tumour together with the all lung and diaphragm. This radical procedure was recently showed to be potentially detrimental. Recent publications have emphasized the importance of preserving the lung. Most mesothelioma surgeons now offer an alternative procedure known as radical pleurectomy / decortication (P/D) consisting in the surgical removal of the involved pleura, but sparing of the lung. This procedure allows re-expansion of the lung and prevents fluid re-accumulation in the chest cavity, improving thereby the quality of life.
Depending upon the tumour type, stage and the completeness of removal, up to 45% of patients receiving multimodality therapy can live five years and beyond according to very recent publications.

At both London Bridge Hospital and The Harley Street Clinic, our team provides a full service for this condition including radiotherapy, chemotherapy, minimally-invasive surgery (VATS pleural biopsy and talc pleurodesis), and multimodality therapy involving pleurectomy / decortication or extra-pleural pneumonectomy.

Professor Lang-Lazdunski has accumulated a large experience with these operations and our anaesthetists and critical care physicians are used to look after patients following these complex procedures. In the past 10 years we have not had any mortality after P/D in more than 120 patients. This is the lowest mortality reported worldwide. More than 97% of our patients were able to receive chemotherapy or / and targeted therapy after surgery and the vast majority of them returned to normal activities after a few weeks.