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    Cytoreductive surgery with hyperthermic intrathoracic chemotherapy for malignant pleural mesothelioma: a systematic review

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    Author
    Dawson, Alan
    Kutywayo, Kudzayi
    Fennell, Dean
    Fakis, Apostolos
    Keyword
    Asbestos induced lung disease
    Mesothelioma
    Pleural disease
    Thoracic surgery
    Date
    2022-04-11
    
    Metadata
    Show full item record
    DOI
    10.1136/thoraxjnl-2021-218214
    Publisher's URL
    https://thorax.bmj.com/content/78/4/409
    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.
    Citation
    Dawson, A. G., Kutywayo, K., Mohammed, S. B., Fennell, D. A., & Nakas, A. (2023). Cytoreductive surgery with hyperthermic intrathoracic chemotherapy for malignant pleural mesothelioma: a systematic review. Thorax, 78(4), 409–417. https://doi.org/10.1136/thoraxjnl-2021-218214
    Type
    Article
    URI
    http://hdl.handle.net/20.500.12904/16613
    Collections
    Cancer
    Thoracic Surgery

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