Table 4.

Outcomes associated with various treatment options for patients with locally recurrent malignant pleural mesothelioma

Treatment	Locoregional Recurrence	Survival	Complications
Supportive Care	n/a	Median OS 9–12 mo	n/a
Extrapleural Pneumonectomy	33–42% (site of first recurrence)	Median OS 12–32 mo	5–10% perioperative mortality
Pleurectomy/Decortication	53–65% (site of first recurrence)	Median OS 12–26 mo	3–6% perioperative mortality
Heated Intraoperative Chemotherapy	17–54% (site of first recurrence)	Median OS 12–26 mo	Increased rates of diaphragmatic patch failure, DVT, ARDS, and atrial fibrillation
Systemic Chemotherapy	Median PFS 5.7–10 mo	Median OS 12.1–29.1 mo (if extrapleural penumonectomy + radiotherapy completed)	27.2% grade III or higher complications
Heated Povidone-Iodine	Median PFS 12 mo (89.5% local-first recurrence)	Median OS 32 mo (with pneumonectomy/decortication, radiation therapy, and adjuvant chemo)	Persistent air leak, chylothorax, pneumonia, empyema, ARDS
Intensity Modulated Radiation Therapy	12% at 1 year	1-year OS 55%	6% fatal pulmonary toxicity
Photodynamic Therapy	Median PFS 9.6 mo	Median OS 15–31.7 mo (with surgery)	Skin burning, pain, cellulitis

OS, overall survival; PFS progression free survival; DVT, deep venous thrombosis; ARDS, acute respiratory distress syndrome