Recurrence of malignant pleural mesothelioma at the resection borders--local or distant recurrence?

Journal of Thoracic Oncology® • Volume 8, Number 7, July 2013 We congratulate Gomez et al for their very important contribution on the patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy, for malignant pleural mesothelioma. Studies about patterns of failure are of great importance because patterns of local and distant failure might be the most important test of adequate treatment planning and treatment success. After extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy, only 16% of the patients experienced local recurrence, whereas, distant recurrence was observed in 59% of the patients. If we go into details, the predominant site of distant recurrence was contralateral hemithorax in the majority of the patients (41%; n = 35) followed by abdomen and pelvis, including liver in 28% of the patients (n = 24). In general, distant recurrence is defined as tumor that has spread to organs or tissues distant from the primary tumor. However, contralateral hemithorax and abdomen are located directly at the resection borders. Contralateral pleura and peritoneum could be opened accidentally during extrapleural dissection in the anterior or posterior mediastinum and diaphragmal resection. Tumor cell dislocation might Servet Bölükbas, MD, PhD Department of Thoracic Surgery Dr.Horst-Schmidt-Klinik Teaching Hospital of Johannes Gutenberg University, Mainz Wiesbaden, Germany