Pleural Dissemination Research Articles

Salvage cytoreductive surgery for pleural dissemination of low-grade endometrial stromal sarcoma using rib-cross thoracotomy with argon beam coagulation: strategies to achieve a grossly complete resection—a case report

Salvage cytoreductive surgery for pleural dissemination of low-grade endometrial stromal sarcoma using rib-cross thoracotomy with argon beam coagulation: strategies to achieve a grossly complete resection—a case report

New horizons in non-small-cell lung cancer patients with ipsilateral pleural dissemination (M1a): review of the literature.

Non-small cell lung cancer (NSCLC) with ipsilateral pleural dissemination (pM1a) is generally contraindicated for surgery owing to the extremely poor survival. However, some studies have demonstrated that primary tumor resection (PTR) may prolong the survival of these patients. Besides, with the development of systemic therapy, it is still hard to decide the best therapy model for pM1a patients. Thus, we reviewed essential studies about NSCLC with pleural disease and summarized the progress of new techniques in recent years, trying to provide promising new horizons about the management of pM1a patients. Firstly, we suggest performing PTR for highly selected pM1a patients, combined with appropriate systemic therapies and follow-up strategies. Secondly, hyperthermic intrathoracic chemotherapy (HITHOC) can control the symptoms and prolong the survival of NSCLC patients with malignant pleural effusion (MPE). It could also combine with PTR together. Finally, application of genetic testing and circulating tumor DNA (ctDNA) monitoring may furthermore make it possible for personalized management of pM1a patients in the future.

Local radiotherapy for pleural dissemination of thymic tumors after initial treatment.

Pleural dissemination is a common pattern of failure after initial treatment of thymoma and thymic carcinoma, but there is no standardized treatment. As these tumors are relatively radiosensitive, we investigated the effectiveness of radiotherapy. Twenty patients underwent 33 series of local radiotherapy for 96 pleural dissemination lesions after initial treatment. Conventional radiotherapy (CRT), tomotherapy, and combination of the two were employed in 19, 13, and 1 series, respectively. The median follow-up period after the first irradiation for pleural dissemination was 46 months (range, 14–161). For all 20 patients, overall survival (OS) rates from initial radiotherapy for pleural dissemination were 100% at three years and 86% at five years. Progression-free survival (PFS) rates after 33 series of radiotherapy were 30% at three years and 16% at five years. Local control (LC) rates for 96 lesions were 98% at three years and 96% at five years. In-field recurrence was observed in only two among the 96 lesions. One patient (5%) developed grade 3 radiation pneumonitis and another (5%) developed grade 3 pericardial effusion. No other serious adverse events were observed. When disseminated nodules can be covered within localized fields, local radiotherapy may be a treatment option. Using tomotherapy, multiple lesions can be treated safely.

Calcification in thymomas can predict invasiveness to surrounding organs

BackgroundThymomas are the most common type of anterior mediastinal tumors. Calcification is sometimes observed in thymomas using computed tomography (CT), and it is more frequent in invasive thymomas than in noninvasive thymomas. However, the significance of calcification in thymomas remains unknown. This study aimed to evaluate the significance of calcification in thymomas on invasiveness to surrounding organs and investigate the characteristics of thymoma cases with calcification at our institution.MethodsWe included thymoma patients treated at our institution between 2000 and 2016, and evaluated their characteristics, including demographics, calcification on CT, histology, Masaoka stage, and myasthenia gravis status. The patients were categorized into calcification (C) and noncalcification (NC) groups.ResultsAmong 51 included patients, 11 (21.6%) had calcification. A higher proportion of group C patients had World Health Organization histological type B2 and B3 tumors (high‐risk) than type A, AB, and B1 tumors (low‐risk; p = 0.0477). The number of patients with Masaoka stages III and IV were significantly higher in the C group than in the NC group (p < 0.0001). The C group patients had significantly higher rates of invasion to the mediastinal pleura, pericardium, lung, phrenic nerve, and chest wall and pleural dissemination than the NC group patients.ConclusionsCalcification reflects invasiveness of tumors to surrounding organs and tissues, and may thus predict thymoma stage and histologically high‐risk thymomas. Calcification in thymomas may also predict the pathological stage and help decide therapeutic methods and surgical approaches to treat thymomas based on the calcification status according to CT findings.

Surgical choice of non-small cell lung cancer with unexpected pleural dissemination intraoperatively

BackgroundWhether patients with non-small cell lung cancer (NSCLC) with unexpected pleural dissemination (UPD) could get survival benefit from tumor resection remained controversial.MethodsTotally, 169 patients with NSCLC with UPD were included between 2012 and 2016. Patients were divided into the tumor resection and open-close group. Progression-free survival (PFS) and overall survival (OS) were compared with a log-rank test. The multivariable Cox analysis was applied to identify prognostic factors.ResultsSixty-five patients received open-close surgery and 104 patients underwent main tumor and visible pleural nodule resection. Tumor resection significantly prolonged OS (hazard ratio [HR]: 0.408, P < 0.001), local PFS (HR: 0.283, P < 0.001), regional PFS (HR: 0.506, P = 0.005), and distant metastasis (HR: 0.595, P = 0.032). Multivariable Cox analysis confirmed that surgical method was an independent prognostic factor for OS, local PFS and regional PFS, except distant metastasis. Subgroup analyses indicated that tumor resection could not improve OS in the patients who received targeted therapy (HR: 0.649, P = 0.382), however, tumor resection was beneficial for the patients who received adjuvant chemotherapy alone (HR: 0.322, P < 0.001). In the tumor resection group, lobectomy (HR: 0.960, P = 0.917) and systematic lymphadenectomy (HR: 1.512, P = 0.259) did not show survival benefit for OS.ConclusionsMain tumor and visible pleural nodule resection could improve prognosis in patients with UPD who could not receive adjuvant targeted therapy. Sublobar resection without systematic lymphadenectomy may be the optimal procedure.

Primary Tumor Resection Improves Survival for EGFR-TKI-Treated Patients With Occult M1a Lung Adenocarcinoma.

BackgroundThe role of primary tumor resection in occult M1a lung adenocarcinoma remains unclear, especially for patients receiving targeted therapy. The purpose of this study is to assess the effect of primary tumor resection on overall survival (OS) in lung adenocarcinoma patients with occult pleural disseminations receiving targeted therapy.MethodsLung adenocarcinoma patients with intraoperatively-confirmed occult pleural dissemination (M1a), who hospitalized in the Department of Thoracic Surgery in Fudan Shanghai Cancer Center from May 2008 to December 2017 and received EGFR-TKIs therapy, were enrolled. Log-rank tests were used to compare the survival differences between groups.Results34 patients receiving EGFR-TKIs were enrolled. The majority of them were never smokers (29/34, 85.3%). Among the enrolled patients, 20 (58.8%) patients underwent primary tumor resection, while 14 (41.2%) patients not. There was no distributional difference of baselines between patients undergoing and not undergoing primary tumor resection. Further analyses demonstrated that the patients undergoing primary tumor resection had a prolonged OS compared with those not (log-rank P= 0.042). The 2-year and 5-year OS for patients receiving primary tumor resection and EGFR-TKIs was 90.0% and 60.1%.ConclusionsPrimary tumor resection was associated with improved survival in patients with occult intraoperatively-confirmed M1a adenocarcinoma receiving EGFR-TKIs.

Debulking surgery for functional pleural dissemination of parathyroid carcinoma-case report

BackgroundA rare cause of primary hyperparathyroidism (PHPT) is a parathyroid carcinoma. Hypercalcemia with an elevated parathyroid hormone (PTH) level seen in recurrent and metastasis disease cases is often refractory to medical therapy, thus surgical resection is recommended when possible. We performed debulking surgery for pleural dissemination of parathyroid cancer for improvement of symptoms in a patient with hypercalcemia.Case presentationA 30-year-old male with hypercalcemia was diagnosed with parathyroid cancer. Following surgery, intact PTH level elevation and hypercalcemia progression due to recurrent disease were noted. An active status of functional left pleural dissemination was revealed in 99mTc-methoxyisobutylisonitrile and somatostatin receptor scintigraphy results, but not in the area of pulmonary metastasis, and debulking surgery was performed. Thereafter, the PTH level was decreased temporarily and activities of daily living improved.ConclusionAggressive resection of metastatic disease in patients with a parathyroid carcinoma is taken into consideration to control hypercalcemia.

Pleural staging using local anesthetic thoracoscopy in dry pleural dissemination and minimal pleural effusion.

BackgroundDry pleural dissemination (DPD) and minimal (<10 mm thick) pleural effusion (PE) may be discovered intraoperatively as unexpected metastases. A definitive diagnostic procedure such as pleural biopsy is rarely attempted in such patients preoperatively. We retrospectively investigated the use and safety of local anesthetic thoracoscopy (LAT) as a pleural staging tool in the diagnosis of DPD and minimal PE.MethodsWe reviewed 18 patients with non‐small cell lung cancer (radiological DPD and minimal PE in 13 and five patients, respectively) who underwent LAT using a flex‐rigid pleuroscope for pleural staging from April 2015 to September 2020.ResultsThe median age of the patients was 72 years. Nine patients (50%) were men. The dominant histological type was adenocarcinoma (n = 16). Three patients each with radiological DPD and minimal PE had visible PE on the LAT. Pleural biopsy was performed in the 16 cases in which pleural abnormalities were identified. On pleural staging, five cases were diagnosed without pleural dissemination (M0), and 13 cases were diagnosed with pleural dissemination (M1a). Only one case in which the lesion could not be identified because of pleural adhesions was false‐negative. The success rates for pleural staging, sensitivity, specificity, positive predictive value, and negative predictive value were 94.4% (17/18), 92.8% (13/14), 100% (4/4), 100% (13/13), and 80.0% (4/5), respectively. There were no lung lacerations or other severe complications caused by the procedure or during blunt dissection.ConclusionLAT might be a useful tool for accurate pleural staging in cases with DPD and minimal PE suspected radiologically.

Near Infrared Photoimmunotherapy for Mouse Models of Pleural Dissemination

The efficacy of photoimmunotherapy can be evaluated more accurately with an orthotopic mouse model than with a subcutaneous one. A pleural dissemination model can be used for the evaluation of treatment methods for intrathoracic diseases such as lung cancer or malignant pleural mesothelioma. Near-infrared photoimmunotherapy (NIR-PIT) is a recently developed cancer treatment strategy that combines the specificity of tumor-targeting antibodies with toxicity caused by a photoabsorber (IR700Dye) after exposure to NIR light. The efficacy of NIR-PIT has been reported using various antibodies; however, only a few reports have shown the therapeutic effect of this strategy in an orthotopic model. In the present study, we demonstrate an example of efficacy evaluation of the pleural disseminated lung cancer model, which was treated using NIR-PIT.

Long-term Survival of Surgically Resected Tracheal Adenoid Cystic Carcinoma After Pleural Dissemination: a Case Report

Long-term Survival of Surgically Resected Tracheal Adenoid Cystic Carcinoma After Pleural Dissemination: a Case Report

A case of neuroblastoma relapsing early after high-dose chemotherapy and causing pleural dissemination

A case of neuroblastoma relapsing early after high-dose chemotherapy and causing pleural dissemination

Surgical treatment strategies for invasive thymoma.

A thymoma is a common anterior thymus mediastinal tumor composed of atypical epithelial tumor cells, though the morbidity rate is lower as compared to other types of thoracic malignancy such as lung cancer and lung metastasis from another primary cancer. As a result, clinical data regarding thymomas have not been well discussed as compared to those of other carcinomas. Also, because of the low morbidity rate and insufficient clinical experience, oncological characteristics and clinical treatment options are poorly understood. Surgical complete resection is the most reliable option for clinical treatment of a thymoma. This tumor can easily develop adjacent to several different structures and nearby organs, such as the pericardium, lungs, and great vessels, which are easily invaded when the size is large, and a combined resection is then needed. When en bloc resection is considered to be difficult based on evaluation with preoperative modalities, induction chemotherapy followed by surgery is recommended. Moreover, when pleural dissemination is revealed during pre- or peri-operative procedures, volume reduction surgery has been reported by several groups to extend prognosis. On the other hand, in cases with a small-sized tumor, a minimally invasive surgical procedure, such as video-assisted thoracic surgery (VATS) or robotic-assisted thoracic surgery (RATS), is usually selected. Because of the wide variety of cases with thymoma, a deliberate strategy and skillful techniques are necessary for effectual surgical treatment. In this review, we discuss strategies that have been shown to be effective for treating patients with early and advanced thymoma, including those with involved adjacent organs.

Tomotherapy for Chemotherapy-Unfit or Chemo-Refractory Multiple Metastases

In spite of chemotherapy innovations, patients with chemotherapy-unfit or chemo-refractory multiple metastases (CUMM/CRMM) rarely survive ≥ 6 months. To treat these patients, we have been using tomotherapy for their multiple metastases and primary tumors. In this study, the efficacy and toxicity of this treatment were evaluated. This multi-institutional prospective study was conducted in 5 hospitals. The inclusion criteria were: 1) CUMM or CRMM with ≥ 3 lesions, 2) age ≥ 18 years, 3) performance status 0–2, and 4) no radiation history to the targets. The CUMM/CRMM definition was those with: a) history of systemic chemotherapy and chemo-refractory status or intolerable toxicities, or b) contraindication of standard chemotherapy because of their general conditions. We excluded patients with prostate cancer, because their life expectancy was ≥ 1-2 years even under supportive care. All radiotherapy was delivered simultaneously using tomotherapy. The main targets were the active lesions with a risk of causing symptoms, but as many other visible lesions as possible were irradiated in order of the volume. The prescribed dose was 55 Gy in 25 fractions. When the risk organ dose exceeded the tolerance level, the prescribed dose was lowered to minimize risks of toxicity. Forty-three patients (median age, 63 years) received the treatment. Eighteen patients were in a chemo-refractory status and 25 were unfit for chemotherapy. The median interval between chemotherapy and irradiation was 4.4 months. The primary tumor included 7 non-small cell lung cancers, 5 endometrial cancers, 5 cervical cancers, 4 ovarian cancers, 4 gastric cancers, 3 pancreatic cancers, and 15 others. Of the 43 patients, 25 with 3-5 lesions, 15 with 6-9, and 3 with ≥ 10 were irradiated. The targets were the lymph node in 155, peritoneal dissemination in 21, bone tumor in 16, pleural dissemination in 15, primary lesion in 13, liver tumor in 9, lung tumor in 8, and lesion in other organs in 3. One patient did not complete the treatment due to cancer aggravation. The 1-year survival rate was 56% (median, 14.5 months). Patients with a larger irradiated volume (≥ 250 cm3) and receiving a higher dose (≥ 50 Gy) survived longer (p < 0.05). The 6-month target control rate was 83%. In 29 patients, new lesions developed out of the irradiated area within 6 months. Twenty-two patients received salvage radiotherapy again. Acute adverse events (≥ grade 2) occurred in 26 patients; hematologic toxicities in 18, dermatitis in 6, and others in 7. Late adverse event (≥ grade 2) occurred in 5 patients; pneumonitis (≥ grade 2) in 4 and gastric hemorrhage (grade 2) in 1. Radiotherapy for CUMM/CRMM is challenging, but the results obtained so far appear promising, considering the short life expectancy of the patients.

Meigs\u2019 syndrome mimicking heart failure with preserved ejection fraction: a case report

BackgroundMeigs’ syndrome is a rare disease characterized by a triad of presentations, including benign ovarian tumor, ascites, and pleural effusion. However, a clinical diagnosis of Meigs’ syndrome remains challenging because pleural and ascitic effusions can be common findings in a variety of underlying conditions. Furthermore, these findings can often be misdiagnosed as pleural and peritoneal dissemination caused by potentially malignant tumors, leading to the administration of improper treatment.Case presentationWe described a case of an 85-year-old postmenopausal female patient with atypical Meigs’ syndrome presenting with right-sided pleural effusion, notable leg edema, and trivial ascites, which was initially mistaken as heart failure with preserved ejection fraction. However, pleural effusion was totally ineffective against diuretic therapy. Subsequently, thoracentesis yielded serosanguineous exudative effusion. Moreover, refractory pleural effusions and abdominal/pelvic computed tomography and magnetic resonance imaging findings strongly suggested bilateral malignant ovarian tumors with pleural dissemination. Repetitive negative cytological results allowed the patient to undergo bilateral salpingo-oophorectomy. Finally, a definitive diagnosis of Meigs’ syndrome was made by confirming the presence of a benign mitotically active cellular fibroma of the ovary by pathology and that pleural effusion resolved following tumor resection.ConclusionsOur case highlights the clinical importance of assessing Meigs’ syndrome in the diagnostic workup of pleural effusion in postmenopausal female patients. Given the favorable prognosis of Meigs’ syndrome, clinicians should consider surgical resection, even with potentially malignant ovarian tumors with accompanying pleural effusion, ascites, or both.

Predictive factors related to pleural dissemination in non-small cell lung cancer.

BackgroundThe prognosis of non-small-cell lung cancer (NSCLC) patients with pleural dissemination is poor, and pleural dissemination is generally considered a contraindication for radical surgery. However, if pleural dissemination is missed intraoperatively, patients with false-negative stage IV NSCLC cannot receive appropriate chemotherapy, and their prognosis might worsen.MethodsIn the present study, we enrolled 144 patients who received surgery for NSCLC between January 2008 and December 2019 with available data on the maximum standardized uptake value (SUVmax) on positron emission tomography (PET) with lesions adjacent to the visceral pleura and without lesions invading the chest wall.ResultsSeven patients who had pleural dissemination were compared with 137 patients who had not pleural dissemination. The relationships between pleural dissemination and the clinicopathological variables were analyzed, and significant differences in the histopathological type (P=0.03), and differentiation (P<0.01) were noted. It was suggested that squamous cell carcinoma tended not to show dissemination to the pleural cavity. The logistic regression analyses of the predictive factors related to pleural dissemination in non-squamous cell carcinoma patients were analyzed, and the age (P=0.01) and differentiation (P<0.01) were identified as significant predictive factors related to pleural dissemination.ConclusionsCases with non-squamous cell carcinoma, a young age, and poor differentiation of undifferentiated grade of histological differentiation are factors associated with early pleural cavity dissemination.

Primary tumor resection of non-small cell lung cancer patients with ipsilateral pleural dissemination (M1a) in the era of targeted therapy.

BackgroundNon‐small cell lung cancer (NSCLC) patients with ipsilateral pleural dissemination (M1a) are generally contraindicated for surgery. Recently, several studies have demonstrated that these patients might benefit from primary tumor resection (PTR). However, whether PTR is beneficial for driver oncogene‐positive patients treated with targeted therapy, remains unclear. Here, we investigated the effects of PTR on survival in the era of targeted therapy.MethodsIn total, 105 NSCLC patients with ipsilateral pleural dissemination were identified. The mode of systemic treatment was assessed in this study. Survival analysis was performed with the Kaplan‐Meier method and Cox proportional hazards regression. The overall survival (OS) of patients with or without PTR was compared between propensity score‐matched groups (caliper: 0.02).ResultsIn the entire cohort, PTR was associated with improved OS in both unmatched (median survival time [MST]: 50.0 vs. 29.6 months, P = 0.019) and matched (MST: 50.0 vs. 34.4 months, P = 0.052) cohorts. Multivariate regression models showed that surgery was an independent favorable prognostic factor for OS. A total of 70 patients underwent genetic testing, and targeted therapies, such as EGFR‐TKIs or ALK‐TKIs, were used in the driver oncogene‐positive patients. Subgroup analysis showed that PTR did not improve OS in the targeted therapy group (MST: 57.1 months vs. 50.4 months, P = 0.840). However, surgery significantly prolonged survival in the nontargeted therapy group (MST: 39.8 vs. 14.2 months, P = 0.002).ConclusionsThe results of this study indicated that PTR could prolong OS in stage IV NSCLC patients with ipsilateral pleural dissemination, especially in patients who are not candidates for targeted therapy.Key points Non‐small cell lung cancer patients with ipsilateral pleural dissemination can benefit from primary tumor resection.Primary tumor resection could prolong overall survival (OS) in non‐small cell lung cancer patients with ipsilateral pleural dissemination who are not candidates for targeted therapy.

Inter- and Intratumor Heterogeneity of EGFR Compound Mutations in Non–Small Cell Lung Cancers: Analysis of Five Cases

BackgroundSeveral clinical and preclinical studies suggest that non–small cell lung cancers (NSCLCs) with EGFR compound mutations were associated with lower efficacies of first-generation EGFR inhibitors than tumors with single EGFR mutation. Some researchers hypothesize that EGFR mutation status is heterogeneous in such tumors and that second-generation EGFR inhibitors may eliminate cancer cells with uncommon EGFR mutations from tumors with EGFR compound mutations. However, this hypothesis is currently unproven; therefore, we performed the current study to determine if tumor cells with EGFR compound mutations are present in heterogeneous or homogeneous manners. Patients and MethodsMultiregion analysis was performed for surgically resected primary NSCLC tumors with EGFR compound mutations to examine the intratumor heterogeneity of EGFR compound mutations. In addition, we evaluated the intertumor heterogeneity of EGFR compound mutations using 2 pleural disseminations obtained from a patient with NSCLC at exploratory thoracotomy and 9 primary or metastatic lesions obtained from 2 autopsied NSCLC patients. Digital polymerase chain reaction, target sequencing, or direct sequencing were used to detect EGFR mutations. ResultsThis study included 5 NSCLC cases; their compound mutations were L858R+S768I, G719X+S768I, G719A+R776H, L858R+E709G, and L858R+I759M. Noncancerous pulmonary tissues from each patient did not harbor EGFR mutations, which revealed that all mutations were somatic. We did not detect any intra- or intertumor heterogeneity in these EGFR compound mutations. ConclusionNo intra- or intertumor heterogeneity was observed for EGFR compound mutations. Our results indicate that both EGFR mutations were truncal and selective elimination of cancer cells with uncommon EGFR mutations is unrealistic.

The role of palliative radiation therapy in treating pleural or peritoneal disseminated tumors: 22 cases and a review of the literature.

Local radiation therapy (RT) can provide pain relief and reduce bleeding resulting from pleural or peritoneal dissemination of primary tumors. However, the optimal RT exposure dose for such tumors is unclear and the response rate is unknown. In this study, we examined the effectiveness of palliative RT for pleural or peritoneal disseminated tumors to determine the optimal dose in these patients. The data of 22 patients with pleural- or peritoneal-disseminated tumors who were treated with local RT at our institution between 2011 and 2019 were retrospectively reviewed. Among these patients, 9 (40.9%) had pleural tumors, 13 (59.1%) had peritoneal tumors and 2 had tumors in the peritoneum and umbilicus. The most common primary tumors were lung (22.8%) and pancreatic cancer (18.2%). RT was mainly administered for pain alleviation (72.7%). Three patients (13.6%) received RT for hemostasis. Thirteen patients (59.1%) received a regimen of 30 Gy/10 fractions (fr), with the total dosage for all patients ranging from 27 to 56 Gy. No grade 2 or higher RT-related adverse events occurred. Three and four patients obtained complete and partial responses, respectively. The timing of the measurement of response to pain relief ranged from 0 to 232 (median, 21) days upon completion of RT. Overall response to pain relief occurred in nine of 16 patients (56.3%) with pain before RT. Hemostasis was confirmed in 2 of the 3 patients (66.7%) with bleeding before RT. Twelve of 20 (60%) patients with symptoms before RT responded to RT. Disease-specific survival (DSS) time after RT ranged from 1 to 656 (median, 106) days. Prompt palliative administration of RT to patients with advanced disease to alleviate pain from disseminated tumors may achieve therapeutic efficacy.

Surgical management of thymic epithelial tumors.

Resection is the mainstay of treatment for thymic epithelial tumors (TETs), with complete removal of the tumor and involved organs being the ultimate aim. The choice of surgical approach plays a major role in defining treatment success, and the optimal choice of method should thus provide an adequate surgical view to achieve complete tumor resection. While median sternotomy is considered the gold standard for access to the mediastinum, several minimally invasive approaches to thymectomy have been described, including video-assisted robotic-assisted thymectomy, although the oncological outcomes of that procedure remain unclear. A multimodal approach incorporating chemotherapy or chemoradiotherapy followed by extended surgery may improve resectability and outcomes for patients with advanced TETs. Surgical debulking is also reportedly acceptable for invasive thymoma because of its potential for achieving favorable outcomes. Re-resection is an acceptable option for patients with recurrent thymoma after initial resection, and repeat resection for recurrent pleural dissemination seems effective. Here, the literature on current clinical practices in the surgical management and treatment of TETs is reviewed.

Five Years PLEURATUMOR Register of the German Society of Thoracic Surgery

Since 01.01.2015, the nationwide "PLEURATUMOR Register of the German Society of Thoracic Surgery (DGT)" has documented the most relevant parameters of patients with primary and secondary malignant pleural diseases receiving thoracic surgery in Germany. This online database is intended to record both primary and recurrent diseases. In particular, the registry focuses on the documentation of patients with pleural carcinosis, malignant pleural mesothelioma and tumours of the thymus with pleural dissemination. A structured evaluation of all patients documented up to and including December 2019 was carried out. At this time, 33 departments participated in the PLEURATUMOR Register and 670 patients have been recorded. Of these patients, 522 data sets were complete and 516 patients received surgical treatment. Most patients were documented in 2017 (n = 135; 26.2%), and in 2019 (n = 72; 14%). With 317 listed patients (61.4%), pleural carcinosis was the most frequently reported pleural tumour, followed by malignant pleural mesothelioma (n = 175; 33.9%) and thymoma/thymic carcinoma with pleural metastases (n = 11; 2.1%). The majority of patients (n = 499; 96.7%) were treated because of an initial manifestation. The most frequently documented procedure was VATS-talcum pleurodesis (n = 204; 39.5%). In 69 patients (13.4%) hyperthermic intrathoracic chemotherapy was performed after cytoreductive surgery. Postoperative complications occurred in 107 patients (20.7%); in 35 cases (6.8%) surgical revision was necessary. The overall 30-day mortality was 8.3% (n = 43). Due to the consistent data entry of the participating clinics, a representative dataset of pleural tumour diseases could be recorded. In the future, we hope for consistent continuation of data entry and the initiation of register-based studies.