Locoregional therapies in advanced and recurrent pleural mesothelioma: A systematic review.

[BACKGROUND] Locoregional therapies, including radiotherapy, surgery and other ablative techniques, are occasionally used as strategies to manage oligorecurrent or oligoprogressive pleural mesothelioma. Yet, their real-world utilization, safety and efficacy remain poorly defined.

[METHODS] We conducted a systematic review in accordance with PRISMA guidelines. A search was conducted in MEDLINE, Scopus, Academic Search Premier and ProQuest Central up to June 2025 for retrospective and prospective studies of surgical cytoreduction, radiotherapy, or other local interventions in oligorecurrent or oligoprogressive pleural mesothelioma. Data on patient demographics, treatment protocols, local control (LC), progression-free survival (PFS), overall survival (OS) and toxicity were extracted and synthesized descriptively.

[RESULTS] A total of 22 studies, all retrospective, encompassing 234 patients, were included. Radiotherapy series (n = 142 patients) reported one-year LC rates ranging from 73.5 to 100 %, a median PFS of 5.1-8.0 months, a median OS of 26.9-38.0 months and grade 3-4 toxicities in ≤ 13 % of patients. Surgical series of oligorecurrences (n = 67 patients) demonstrated OS ranging from 14.5 to 44.6 months, with rare long-term survivors after distant resections. A single series of percutaneous cryoablation (n = 24 patients) achieved a 90.8 % local recurrence free-survival rate at one year with minimal toxicity; a single radiofrequency ablation case yielded a 24-month PFS.

[CONCLUSIONS] Retrospective evidence suggests that locoregional interventions can achieve long-term local control and acceptable safety in selected pleural mesothelioma patients with oligorecurrent or oligoprogressive disease. Prospective trials are warranted to establish optimal patient selection and strategies integrating these approaches into standard care.