Treatment for Oligo-recurrence of Diffuse Pleural Mesothelioma After Extended Pleurectomy/Decortication

We evaluate recurrence patterns and assess the efficacy of local treatment for oligo-recurrence in patients with diffuse pleural mesothelioma (PM) following extended pleurectomy/decortication (P/D) with multimodal therapy.

This retrospective study included 69 patients with PM treated at the Institute of Science Tokyo Hospital from October 2010 to September 2025. All the patients underwent extended P/D and intraoperative hyperthermic cisplatin perfusion. Oligo-recurrence was defined as a small number of recurrences that would be treated with local treatment. Recurrence patterns, treatments, and survival outcomes were examined.

Macroscopic complete resection was achieved in all patients, and there was one in-hospital mortality (1.4%). Sixty-one patients (88.4%) received multimodal therapy. Recurrence occurred in 52 patients (75%). The median recurrence-free survival (RFS) was 15.0 months. The type of recurrence was local in 32 (62%) patients, distant in six (12%), and both in 14 (27%). Local treatment (second surgery 14; radiation therapy 2) was administered to 16 patients with oligo-recurrence. Chest wall excision was the most common surgical procedure. Seven patients underwent repeated local treatments (surgery 20; radiation therapy 7). The median post-recurrence survival (PRS) of 52 patients was 13.9 months. The PRS with systemic chemotherapy was 11.4 months, while the PRS with the addition of oligo-recurrence treatment was 45.6 months. Multivariate analysis revealed that disease-free interval and oligo-recurrence were significantly favorable factors for PRS.

Local treatment, a second surgery and radiation therapy, for oligo-recurrence of PM after extended P/D showed a favorable survival outcome. Tailored treatment for recurrent PM is warranted.