207O - Extended pleurectomy decortication for malignant pleural mesothelioma in the elderly – the need for an inclusive yet selective approach

Date 14 April 2016
Event European Lung Cancer Conference 2016 (ELCC) 2016
Session Multidisciplinary management of thoracic malignancies
Topics Geriatric Oncology
Mesothelioma
Surgery and/or Radiotherapy of Cancer
Presenter Annabel Sharkey
Citation Journal of Thoracic Oncology (2016) 11 (supplement 4): S57-S166. S1556-0864(16)X0004-4
Authors A.J. Sharkey, S. Tenconi, A. Nakas, D. Waller
  • Thoracic Surgery, Glenfield Hospital, LE39QP - Leicester/GB

Abstract

Background

The median age at diagnosis of patients with malignant pleural mesothelioma in the UK is 72 years. In order to consider radical surgery we have employed extended pleurectomy decortication (EPD) in favour of extrapleural pneumonectomy given the strict selection criteria required. Recent series have shown the feasibility of EPD in the elderly but with continuing debate about the efficacy of this treatment, we reviewed our experience to identify more detailed selection criteria.

Methods

We reviewed prospectively collected data on all patients from 1999 to 2015 undergoing EPD with the intent of achieving macroscopic complete resection. We compared clinical, pathological, outcome and survival data from patients 70 years and over (>70) with those younger than 70 years (

Results

Seventy nine of 282 patients (28.0%) were 70 years or over at the time of surgery. There were no differences in demographic or pathological characteristics between the two groups. A higher proportion of patients in the elderly group required intensive care post-operatively (5.4% vs. 16.8% p = 0.004) and developed atrial fibrillation (14.4% vs. 24.7% p = 0.051). There was no difference in median length of hospital stay (70; 14 days (range 2–93 days) p = 0.118). There was no intergroup difference in in-hospital (3.5 vs 6.5% p = 0.323), or 90-day mortality (7.9 vs. 10.1% p = 0.635) Elderly patients were less likely to receive adjuvant chemotherapy (45.7% vs. 29.6% p = 0.040) but overall survival was similar; 10.5 months vs. 13.0 months (p = 0.683) However, in node positive patients, survival was significantly decreased in the elderly with non-epithelioid tumours (3.8 vs. 6.6 months p = 0.024) On multivariate analysis, age was not a significant prognostic factor, although lack of adjuvant therapy (HR 2.088, 95%CI 1.372–3.176, p = 0.001) and pre-operative anaemia (HR 1.976, 95%CI 1.294–3.017, p = 0.002) remained poor prognostic factors.

Conclusions

Whilst age in isolation should not be an exclusion criteria for EPD for mesothelioma, in the elderly a more rigorous preoperative evaluation of nodal disease and an additional assessment of fitness for adjuvant chemotherapy, or the consideration of neoadjuvant therapy are recommended.

Clinical trial identification

Legal entity responsible for the study

University of Leicester Hospitals

Funding

University of Leicester Hospitals

Disclosure

All authors have declared no conflicts of interest.