Cold-plasma coagulation in the treatment of malignant pleural mesothelioma: results of a combined approach.
Malignant pleural mesothelioma is on a continuous rise throughout the Western countries. It is associated with asbestos fibre exposition in the past. Surgical approaches include extrapleural pneumonectomy and pleurectomy/decortication (P/D). We investigated the feasability of the implementation of cold-plasma coagulation (CPC) on the pleura, pericardium and diaphragm into an established therapeutic algorithm consisting of P/D and hyperthermic intrathoracal chemoperfusion (HITHOC) therapy. The underlying rationale was the prevention of cardiotoxic effects during HITHOC as well as accidental translocation of malignant cells to the abdomen. CPC was done as part of a multimodal therapy in stage III mesothelioma patients. Histologic examinations of pleural excisates after CPC were done. The patients were followed up in three-month intervals. Neither parenchymal fistulas, nor cardiotoxic effects were observed. The histologic examination of the pleural excisates showed complete predictable necrosis. Moreover, until now (median time after operation 1 year) no relapse of the disease was observed. CPC proved to be a safe technique when used on the pleura, pericardium and diaphragm. We consider our trial as a pilot-study. To evaluate potential survival benefits using this technique larger trials are mandatory.
Hoffmann
Martin
M
Surgical Clinic, University Clinic Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany.
Bruch
Hans-Peter
HP
Kujath
Peter
P
Limmer
Stefan
S
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects; D008297:Male; D008654:Mesothelioma / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D010865:Pilot Projects; D010997:Pleural Neoplasms / Q000473:pathology / Q000628:therapy*; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
D004317:Doxorubicin; D002945:Cisplatin