Oncological Outcomes Of Radical Surgery With And Without Induction And Adjuvant Chemotherapy In Mesothelioma Patients – 8-Year Experience In A Single Center

Abstract

Introduction: Mesothelioma is a devastating, insidious disease with a long latency period. Its peak incidence occurs in the 5th and 6th decades of life, up to 40 years after asbestos exposure which is strongly related to the disease. The optimal treatment is the object of an intense discussion.
Aims: The established outcomes were disease-free survival (DFS) and 1-year survival analyzed in the context of neoadjuvant chemotherapy with subsequent surgery, surgical intervention without any systemic treatment, an upfront surgery and adjuvant chemotherapy and surgical intervention with both neo- and adjuvant therapy to establish the most advantageous treatment in terms of oncological results.
Materials and Methods: We analyzed our center’s surgical experience with radical surgery for mesothelioma, evaluating the disease-free time and 1-year survival in relation to the treatment scheme. A search of the department’s surgical database for mesothelioma cases between January 2016 and December 2020 revealed 16 cases, which were included in the final analysis. The established outcomes were disease-free survival and 1-year survival.
Results: The 3 patients treated with surgery without any systemic treatment had a median follow-up period (MFUP) of 7 months (3- 12), 67% of recurrence, DFS of 6 months (0-12), and 1-year survival of 33%. The 6 patients treated with neoadjuvant chemotherapy, surgical resection, and adjuvant therapy, had an MFUP of 45 months (8-82), 67% of recurrence, DFS of 32 months (2-82), and 1-year survival of 83%. The 1 patient, treated with neoadjuvant chemotherapy and subsequently, surgery had a follow-up of 29 months with DFS of 20 months and he was alive at the time of submission of this article. The 6 patients treated with an up-front surgery and adjuvant chemotherapy had an MFUP of 20 months (8-33), 67% of recurrence, DFS of 15 months (6-33), and 1-year survival of 67%.
Conclusion: Despite the limitations of the study, the multimodal approach with both neoadjuvant and adjuvant chemotherapy demonstrated the longest MFUP, DFS, and 1-year survival. The worst results were observed in patients treated only with radical surgery, while the sequence of systemic treatment did not influence the rate of recurrence.