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

Annals of Surgical Oncology 2026 October [Link]

Ryo Wakejima, Hironori Ishibashi, Ayaka Asakawa, Yuya Ishikawa, Yusuke Sugita, Kenichi Okubo

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.