Changes in pulmonary function tests predict radiological response to chemotherapy in malignant pleural mesothelioma

Our plain-English summary of Changes in pulmonary function tests predict radiological response to chemotherapy in malignant pleural mesothelioma, by G. Marulli, F. Di Chiara, F. Braccioni, et al (European Journal of Cardio-thoracic Surgery, 2013).

The study

• Authors: G. Marulli, F. Di Chiara, F. Braccioni, E. Perissinotto, G. Pasello, A.G. Favaretto, C. Breda, F. Rea
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2013;44(1):104-10
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: Response to chemotherapy in malignant pleural mesothelioma (MPM) is usually evaluated by radiological criteria, but no common agreement exists on their validity, yet. The cytoreductive effect of chemotherapy on pleural thickening may make the lung more expansible, reducing the restrictive ventilatory impairment. The aim of this study was to evaluate the changes in pulmonary function following chemotherapy in patients with MPM and to correlate these findings with radiological changes.

Methods: Between 2004 and 2011, 62 consecutive patients (74% males, median age 63 years) were prospectively investigated. Modified RECIST criteria were used for radiological evaluation of response to chemotherapy. All patients underwent pulmonary function tests before and after three cycles of platinum-based chemotherapy. Changes between baseline and post-chemotherapy pulmonary function values (Δ) and their differences were assessed by means of Student's paired and unpaired t-test, respectively. Receiver operating characteristic (ROC) curve analysis was performed on spirometric parameters significantly associated with response.

Results: Thirty (48.4%) patients had a radiological stable disease (S), 23 (37.1%) a partial response (R) and 9 (14.5%) a progressive disease (P). ΔFEV1%pred (R: 18.1 ± 18.5%; S: 0.5 ± 9.3%; P: -11 ± 13.5%; P < 0.0001), ΔFVC%pred (R: 16.1 ± 11.8%; S: 0.4 ± 11.2%; P: -9.2 ± 14.6%; P < 0.0001) and ΔVC%pred (R: 12.9 ± 15.7%; S: 1.5 ± 12.1%; P: -6.1 ± 13.2%; P = 0.001) were significantly associated with radiological response. A significant correlation was observed between ΔFEV1%pred (r = 0.46, P = 0.01), ΔFVC%pred (r = 0.43, P = 0.02) and % change in linear tumour measurement. ROC curve analysis using dichotomized radiological response (P/S vs R) as classification variables showed AUC = 0.88 (95%CI: 0.77-0.95) for ΔFEV1%pred (optimal cut-off value: +7%, sensitivity: 83%, specificity: 82%, PPV: 73%, NPV: 89%) and AUC = 0.86 (95%CI: 0.75-0.94) for ΔFVC%pred (optimal cut-off value: +6%, sensitivity: 82%, specificity: 74%, PPV: 64%, NPV: 88%).

Conclusions: Dynamic lung volumes and radiological changes after chemotherapy seem directly related. Lung function changes could be an additional tool to better evaluate the response to chemotherapy in MPM.

In plain English

This prospective study, done at the University of Padua in Italy between 2004 and 2011, followed 62 consecutive patients with malignant pleural mesothelioma (MPM). Of these, 55 (88.7%) had a history of asbestos exposure. All received three cycles of pemetrexed with cisplatin or carboplatin. Breathing tests and CT scans were done before and after treatment. Tumour response on CT was judged with modified RECIST criteria. On CT, 23 patients (37.1%) had a partial response, 30 (48.4%) stable disease and 9 (14.5%) progressive disease. Across all patients, several breathing measures rose significantly after chemotherapy. When patients were grouped by response, FEV1 (air blown out in one second), FVC and VC improved significantly only in partial responders. These measures stayed about the same with stable disease and fell with progressive disease. A rise of 7% in FEV1 was the best cut-off for picking out partial responders (sensitivity 0.83, specificity 0.82). The authors concluded that changes in lung function could be an additional tool for judging response to chemotherapy. They noted that pain, earlier pleurodesis, small leftover fluid and patient effort could have affected the breathing tests.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: prospective study comparing lung function tests before and after chemotherapy with CT-measured tumour response
• Who was studied: 62 consecutive patients with malignant pleural mesothelioma (IMIG clinical stage I to III, ECOG performance status 0 to 1), Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Italy, 2004 to 2011; 46 (74.2%) male, median age 63 years (range 40 to 76); 42 (67.7%) were stage III
• Exposure: The exposure studied was three cycles of platinum-based chemotherapy: 32 patients (51.6%) received carboplatin and pemetrexed, and 30 (48.4%) received cisplatin (spelled 'cysplatinum' in the article) and pemetrexed. Asbestos exposure was recorded as background: 55 of 62 patients (88.7%) were exposed (45 occupational, 10 environmental), and 7 (11.3%) were not. No fiber types were reported.
• Main results:
  • Radiological response after chemotherapy: 23 patients (37.1%) partial response, 30 (48.4%) stable disease, 9 (14.5%) progressive disease
  • In the whole group, percentage of predicted FEV1, VC, FVC and TLC increased significantly after chemotherapy (for example, FEV1 % predicted went from 74.61 ± 14.37 to 77.91 ± 16.41, P 0.02). DLCO did not change significantly (61.65 to 61.68 % predicted, P 0.95).
  • By response group, FEV1, FVC and VC improved significantly only in patients with a partial response; lung function stayed unchanged with stable disease and worsened with progressive disease
  • Relative change in FEV1 % predicted was 18.1 ± 18.5% in partial responders, 0.5 ± 9.3% with stable disease and −11 ± 13.5% with progressive disease (p less than 0.0001)
  • Change in FEV1 correlated with percentage change in total tumour measurement (r = 0.46, P = 0.01), as did change in FVC (r = 0.43, P = 0.02)
  • In ROC analysis (partial response versus stable or progressive disease), the best cut-off was a +7% change in FEV1 (AUC 0.88, 95% CI 0.77 to 0.95; sensitivity 0.83, specificity 0.82). For FVC it was +6% (AUC 0.86, 95% CI 0.75 to 0.94; sensitivity 0.82, specificity 0.74). For VC it was +3% (AUC 0.76, 95% CI 0.64 to 0.86; sensitivity 0.73, specificity 0.74).
• The authors' conclusion: The authors concluded that dynamic lung volumes and radiological changes after chemotherapy were directly related. In their view, lung function changes could be an additional tool to better evaluate response to chemotherapy in MPM.
• Limitations the authors state:
  • Chest pain that was not always well controlled could have impaired lung function test results
  • Most patients had pleurodesis during diagnostic VATS, and the authors could not evaluate its influence on lung function tests or radiological assessment
  • Small amounts of residual pleural effusion were accepted and could be a confounding factor
  • Lung function tests depend on patient compliance and motivation, which may have differed before and after treatment, particularly in patients with progressive disease or poor symptom control

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pulmonary Function Test (PFT), Chemotherapy, Pleural Mesothelioma, Cytoreductive Surgery, Pleural Thickening, Modified RECIST (mRECIST).

Related studies

• Pulmonary function of nonsmoking female asbestos workers without radiographic signs of asbestosis — X.R. Wang, E. Yano, et al. (1998)
• Effect of induction chemotherapy on lung function and exercise capacity in patients affected by malignant pleural mesothelioma — G. Marulli, F. Rea, et al. (2010)
• Findings from high resolution computed tomography of the lung and pleura of symptom free workers exposed to amosite who had normal chest radiographs and pulmonary function tests — S. Neri, A. Antonelli, et al. (1994)
• The relative importance of clinical, radiological and pulmonary function variables in evaluating asbestosis and chronic obstructive airway disease in asbestos workers — G.M. Regan, B. Tagg, et al. (1971)
• Relationship between chest X-ray findings and pulmonary function tests in dust workers — Y. Tonori, M. Niitsuya, et al. (2005)
• Pulmonary function in asbestosis: serial tests in a long-term prospective study — M.E. Bader, R.A. Bader, et al. (1965)

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