Computed Tomography and Spirometry Can Predict Unresectability in Malignant Pleural Mesothelioma

Area of Science:

• Thoracic oncology
• Surgical oncology
• Medical imaging

Background:

• Malignant pleural mesothelioma (MPM) requires accurate preoperative assessment to avoid non-beneficial surgery.
• Identifying unresectable cases early allows prompt initiation of medical treatments.

Purpose of the Study:

• To identify preoperative predictors of unresectable malignant pleural mesothelioma.
• To evaluate the association between hemithorax contraction and exploratory thoracotomy.

Main Methods:

• Retrospective analysis of 291 patients with intended macroscopic complete resection for mesothelioma post-chemotherapy (1994-2020).
• Inclusion of 58 eligible patients with preoperative CT scans, excluding pleural effusion or hydropneumothorax.
• Collection of lung volumes, modified-Response Evaluation Criteria in Solid Tumors (RECIST) measurements, and spirometries post-chemotherapy.
• Multivariable analysis to determine unresectability predictors.

Main Results:

• Unresectable disease was identified in 25.9% of cases at operation.
• Multivariable analysis revealed total lung capacity (<77.5%) and disease burden (>120.5 mm) as significant predictors of unresectability (p=0.03 and p=0.02, respectively).
• Lung volumes were not independently associated with unresectability due to correlation with disease burden (p < 0.001).

Conclusions:

• Disease burden and total lung capacity are valuable preoperative predictors for malignant pleural mesothelioma unresectability.
• These findings can assist surgeons in decision-making regarding surgical versus non-surgical management in a multimodality context.