Clinical and prognostic features of erionite-induced malignant mesothelioma

Our plain-English summary of Clinical and prognostic features of erionite-induced malignant mesothelioma, by E. Demirer, C.F. Ghattas, M.O. Radwan, et al (Yonsei Medical Journal, 2015).

The study

• Authors: E. Demirer, C.F. Ghattas, M.O. Radwan, E.M. Elamin
• Journal: Yonsei Medical Journal
• Published: 2015;56(2):311-23
• Type of article: Review
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This review analytically examines the published data for erionite-related malignant pleural mesothelioma (E-MPM) and any data to support a genetically predisposed mechanism to erionite fiber carcinogenesis. Adult patients of age ≥18 years with erionite-related pleural diseases and genetically predisposed mechanisms to erionite carcinogenesis were included, while exclusion criteria included asbestos- or tremolite-related pleural diseases. The search was limited to human studies though not limited to a specific timeframe. A total of 33 studies (31042 patients) including 22 retrospective studies, 6 prospective studies, and 5 case reports were reviewed. E-MPM developed in some subjects with high exposures to erionite, though not all. Chest CT was more reliable in detecting various pleural changes in E-MPM than chest X-ray, and pleural effusion was the most common finding in E-MPM cases, by both tests. Bronchoalveolar lavage remains a reliable and relatively less invasive technique. Chemotherapy with cisplatin and mitomycin can be administered either alone or following surgery. Erionite has been the culprit of numerous malignant mesothelioma cases in Europe and even in North America. Erionite has a higher degree of carcinogenicity with possible genetic transmission of erionite susceptibility in an autosomal dominant fashion. Therapeutic management for E-MPM remains very limited, and cure of the disease is extremely rare.

In plain English

This was a review of published studies on malignant pleural mesothelioma linked to erionite, a natural fibrous zeolite, and of evidence for genetic predisposition. The authors included 33 studies covering 31042 patients (22 retrospective studies, 6 prospective studies and 5 case reports). They excluded asbestos- and tremolite-related diseases. The studies covered residents of villages in central Turkey, Turkish immigrants in Sweden and Germany, and one case in North America. Pleural effusion was the most common finding on chest X-ray (89 of 260 erionite cases with data, 34.2%) and on chest CT (14 of 23 patients in one study, 60.8%), and CT detected pleural changes more reliably. In one village study, 119 of 372 deaths over 23 years of follow-up were from mesothelioma. In one study of 135 cases, median survival from diagnosis was 13.52 months for erionite-related cases and 21.56 months for asbestos-related cases. A family-tree study of 526 people suggested that mesothelioma was probably inherited in an autosomal dominant pattern. The authors concluded that treatment options remain very limited and that cure is extremely rare. They noted that differences between the studies prevented a combined statistical analysis.

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: Review of published human studies (headed 'Review Article' and titled by the authors a 'Systemic Review'); the included studies were scored with a scale adapted from Jadad and rated by the Oxford evidence scheme
• Who was studied: 33 studies totalling 31042 patients: adults (18 or older) with erionite-related diseases, plus studies of genetic predisposition in high-risk families with mesothelioma. The studies concerned residents of villages in the Cappadocia region of central Turkey, Turkish immigrants in Sweden and Germany, and one North American case report.
• Exposure: Erionite, a natural fibrous zeolite (not asbestos); asbestos- and tremolite-related diseases were excluded
• Main results:
  • On chest X-ray in erionite-related mesothelioma, pleural effusion was the most common finding at 34.2% (89 of 260 in the erionite totals of Table 4), with interstitial changes at 33.9% (122 of 360)
  • On chest CT in erionite-related mesothelioma, pleural effusion was the most common finding at 60.8% (14 of 23, from a single study), followed by pleural calcification at 41% (36 of 88), pleural thickening at 34.8% (45 of 129) and pleural nodules at 34.7%
  • The authors found chest CT more reliable than chest X-ray in detecting pleural changes in erionite-related mesothelioma
  • In one prospective study of 891 residents of two erionite-exposed villages and one control village in Turkey, 372 died over 23 years of follow-up; 119 of these 372 deaths were from mesothelioma
  • In one retrospective study of 135 cases, median survival from diagnosis was 13.52 months for erionite-related cases and 21.56 months for asbestos-related cases (p less than 0.01)
  • A retrospective study of a six-generation family tree of 526 individuals in one village indicated that mesothelioma was probably genetically transmitted in an autosomal dominant fashion
  • PCR testing did not find SV40 virus in any of 29 pleural biopsy specimens from patients with malignant pleural mesothelioma in Turkey
  • In one prospective study of 40 patients, the objective response rate among those who received chemotherapy was 20%, with a median overall survival of 10 months (plus or minus 2)
  • In a prospective study of 20 patients given extrapleural pneumonectomy, high-dose radiation and cisplatin-based chemotherapy, overall median survival was 17 months (24% at 2 years)
• The authors' conclusion: The authors concluded that erionite has caused numerous mesothelioma cases in Turkey and even in North America. They suggested that the observed difference could be due to a higher degree of erionite carcinogenicity or to genetic transmission of erionite susceptibility in an autosomal dominant fashion, and that further studies are needed. They concluded that therapeutic options remain very limited and that cure is extremely rare.
• Limitations the authors state:
  • Differences between patients and the varied diagnostic and treatment regimens prevented a systematic meta-analysis
  • Blinding was not routinely used or reported in several of the reviewed studies, so comparisons of treatment response or survival between erionite- and asbestos-related cases may be biased
  • Co-interventions, other therapies and the timing of end-of-life decisions were not standardized or consistently reported across studies

Topics

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

Medical terms in this study, explained in our Lexicon: erionite, Malignant Mesothelioma, Pleural Mesothelioma, Carcinogenesis, Tremolite, Chest X-Ray, Pleural Effusion, Bronchoalveolar Lavage (BAL).

Related studies

• Erionite bodies and fibres in bronchoalveolar lavage fluid (BALF) of residents from Tuzköy, Cappadocia, Turkey — P. Dumortier, L. Coplü, et al. (2001)
• Prognostic significance of Bax and Fas ligand in erionite and asbestos induced Turkish malignant pleural mesothelioma — N. Kokturk, P. Firat, et al. (2005)
• High incidence of lung cancer and malignant mesothelioma linked to erionite fibre exposure in a rural community in Central Mexico — M.A. Ortega-Guerrero, G. Carrasco-Núñez, et al. (2015)
• Lung diseases due to environmental exposures to erionite and asbestos in Turkey — S. Emri, A. Demir, et al. (2002)
• Erionite exposure in North Dakota and Turkish villages with mesothelioma — M. Carbone, Y.I. Baris, et al. (2011)
• Endemic malignant mesothelioma: exposure to erionite is more important than genetic factors — M. Metintas, G. Hillerdal, et al. (2010)

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