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Original research
Cytoreductive surgery with hyperthermic intrathoracic chemotherapy for malignant pleural mesothelioma: a systematic review
  1. Alan G. Dawson1,2,
  2. Kudzayi Kutywayo1,
  3. Seid B. Mohammed3,
  4. Dean A. Fennell2,4,
  5. Apostolos Nakas1
  1. 1Department of Thoracic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
  2. 2Department of Cancer Studies, University of Leicester, Leicester, UK
  3. 3Department of Statistics, University of Leicester Clinical Trials Unit, Leicester, UK
  4. 4Department of Medical Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
  1. Correspondence to Mr Alan G. Dawson, Department of Thoracic surgery, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, UK; agd9{at}le.ac.uk; Mr Alan G Dawson, Department of Thoracic surgery, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, UK; agd9{at}le.ac.uk

Abstract

Introduction Cytoreductive surgery has been used a part of multimodality treatment in patients with malignant pleural mesothelioma (MPM). The residual microscopic disease that remains will lead to disease progression in the majority of patients. Delivery of hyperthermic intrathoracic chemotherapy at the time of surgery has been used to address this microscopic disease, however it’s effect and place in the multimodality treatment sphere is unknown. The aim of this systematic review was to assess the effect of surgery and hyperthermic intrathoracic chemotherapy in patients with MPM on overall survival and disease-free interval.

Methods Ovid MEDLINE, Embase, Web of Science and the Cochrane Database of Systematic Reviews were searched from database inception through to June 2021. Studies reporting overall survival and/or disease-free interval in patients with MPM undergoing cytoreductive surgery with hyperthermic intrathoracic chemotherapy were considered. Study quality was assessed using the Newcastle-Ottawa Scale. A narrative review was performed.

Results Fifteen studies were eligible for inclusion comprising 598 patients. Surgery with hyperthermic intrathoracic chemotherapy was associated with a median overall survival and disease-free interval ranging from 11 to 75 months and 7.2 to 57 months, respectively. These appeared to be superior to patients not receiving hyperthermic intrathoracic chemotherapy (overall survival: 5–36 months and disease-free interval: 12.1–21 months). A higher dose of hyperthermic intrathoracic chemotherapy was associated with an improvement in overall survival compared with a lower dose: 18–31 months versus 6–18 months, respectively. The most common morbidity was atrial fibrillation followed by renal complications.

Conclusion Surgery with hyperthermic intrathoracic chemotherapy offers a safe and effective therapy with an improvement in disease-free interval and overall survival, particularly when hyperthermic intrathoracic chemotherapy is administered at a higher dose.

PROSPERO registration number CRD42019129002.

  • Mesothelioma
  • Asbestos Induced Lung Disease
  • Pleural Disease
  • Thoracic Surgery

Data availability statement

Most of the data used in this systematic review are included in the article and supplementary material. Where data were unpublished and obtained from the corresponding author of the relevant article, summary statistics can be requested upon reasonable request.

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Data availability statement

Most of the data used in this systematic review are included in the article and supplementary material. Where data were unpublished and obtained from the corresponding author of the relevant article, summary statistics can be requested upon reasonable request.

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Footnotes

  • Contributors AGD is the guarantor of the study. AGD: Conceptualisation, identification of studies, assessment of study quality, contributed to the data collection, extracted the data, contributed to the analysis and produced the results figures and tables, wrote the initial draft of the manuscript, contributed to the writing of the final manuscript. KK: Identification of studies, assessment of study quality, contributed to the data collection, extracted the data, contributed to the analysis and produced the results figures and tables, wrote the initial draft of the manuscript, contributed to the writing of the final manuscript. SBM: Provided statistical support, contributed to the analysis and produced the results figures and tables, contributed to the writing of the final manuscript. DAF: Provided supervision during the study, contributed to the writing of the final manuscript. AN: Resolved any disagreements during the screening of potential studies, study selection and study quality assessment, provided supervision during the study, contributed to the writing of the final manuscript. All authors: Read and commented on the final manuscript submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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