Follow-Up and Survivorship

Patients with limited disease may consider multimodality therapy incorporating radical surgery (extrapulmonary pneumonectomy or radical pleurectomy with decortication) given with or without chemotherapy and/or radiation therapy. Multimodality therapy has been associated with a relatively long survival in observational series.[6][Level of evidence C1] For patients treated with aggressive surgical approaches, the following factors are associated with improved long-term survival:[7,8][Level of evidence C2]

For patients treated with aggressive surgical approaches, nodal status is an important prognostic factor.[7] Median survival has been reported as 16 months for patients with malignant pleural disease and 5 months for patients with extensive disease. In some instances, the tumor grows through the diaphragm, making the site of origin difficult to assess. Cautious interpretation of treatment results with this disease is imperative because of the selection differences among series. Effusions, both pleural and peritoneal, represent major symptomatic problems for at least 66% of patients. For more information, see Cardiopulmonary Syndromes.