Clinical features and current treatment of diffuse malignant pleural mesothelioma

Our plain-English summary of Clinical features and current treatment of diffuse malignant pleural mesothelioma, by V.W. Rusch (Lung Cancer, 1995).

The study

• Author: V.W. Rusch
• Journal: Lung Cancer
• Published: 1995;12 Suppl 2:S127-46
• Type of article: Review
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma is an uncommon cancer for which the major risk factor is prior asbestos exposure. During the past decade, there has been progress in the diagnosis, staging and biology of mesothelioma. Treatment remains controversial and ranges from supportive care alone to aggressive multimodality therapy. Prospective clinical trials in carefully staged patients are needed to determine what approaches to treatment may confer a survival benefit.

In plain English

This 1995 article was a narrative review, not a new study of patients, covering the clinical features, diagnosis, staging and treatment of diffuse malignant pleural mesothelioma. The author described occupational asbestos exposure as the main cause, with at least 20 years between exposure and cancer. Citing published studies, the review reported that pleural fluid cytology found cancer in only 30-50% of patients, while thoracoscopy gave a diagnosis in at least 80%. Chemotherapy response rates were generally 15-20%. Among 105 patients treated at Memorial Sloan-Kettering Cancer Center with surgery and radiation, median survival was 12.6 months, and tumor returned on the same side of the chest in 64 of the 105. Reported operative death rates were 1.8% for pleurectomy/decortication. For extrapleural pneumonectomy, an early report gave 30%, and later data showed a substantial reduction. The author concluded that no combined treatment had yet produced a long-term cure. The author noted that most published series were small and retrospective and that no staging system was fully validated.

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: Narrative review (overview of published literature)
• Who was studied: No new patient population. The review covers published reports on patients with diffuse malignant pleural mesothelioma, with emphasis on treatment.
• Exposure: Occupational asbestos exposure, described as the main risk factor, with a latency of at least 20 years. No specific fiber types are discussed in the body of the review. The review's subject is the disease and its treatment rather than exposure.
• Main results:
  • The review reported that pleural fluid cytology was positive for malignancy in only 30-50% of patients.
  • The review reported that thoracoscopy yielded a diagnosis in at least 80% of patients.
  • Chemotherapy response rates in published phase II studies were generally in the 15-20% range. Rates as high as 30-40% were reported in small single-institution studies.
  • Memorial Sloan-Kettering series: 105 patients were treated from 1976 to 1988 with pleurectomy/decortication, brachytherapy and external beam radiation. Their median survival was 12.6 months, with 1- and 2-year actuarial survival of 52% and 23%.
  • In the same Memorial Sloan-Kettering series, recurrent tumor on the same side of the chest occurred in 64 of the 105 patients (printed as 63%).
  • In a cited report on intrapleural gamma interferon in 22 patients with early-stage disease (Boutin et al.), a 56% overall response rate was observed.
  • An early report (Butchart et al.) gave an operative mortality of 30% for extrapleural pneumonectomy. More recent data showed a substantial reduction.
  • Pleurectomy/decortication was reported to carry a mortality of 1.8%.
  • Dana Farber series: 52 patients were treated from 1980 to 1992 with extrapleural pneumonectomy, CAP chemotherapy and radiation. Overall median survival was 16 months.
  • In the Dana Farber series, patients with epithelial histology had 42% survival at 3 years.
  • In a Memorial Sloan-Kettering trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy, the 27 patients had a median survival of 18.3 months, but virtually all developed local recurrence.
  • Autopsy series cited in the review showed widely disseminated metastases in at least half of all patients at death.
• The authors' conclusion: The author concluded that no combined modality treatment regimen had yet led to a long-term cure.
• Limitations the authors state:
  • The author stated that evaluation of treatments is hampered by a lack of large prospective clinical trials. Most reported series were small and retrospective.
  • The author stated that none of the proposed staging systems was fully validated.
  • The author stated that most published reports staged patients only clinically (by symptoms, physical exam and chest radiographs), which leads to heterogeneous patient groups.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Staging, Mesothelioma, Multimodal Therapy, Clinical Trial.

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• Malignant pleural mesothelioma: current concepts in treatment — A. Tsiouris, R.K. Walesby (2007)
• Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up — R.A. Stahel, W. Weder, et al. (2010)
• Clinical Features and Treatment Outcome of Malignant Pleural Mesothelioma — M. Mencoboni, R.A. Filiberti, et al. (2017)
• Radiological characteristics, histological features and clinical outcomes of lung cancer patients with coexistent idiopathic pulmonary fibrosis — K.A. Khan, M.P. Kennedy, et al. (2015)
• Immunotherapy for Treatment of Pleural Mesothelioma: Current and Emerging Therapeutic Strategies — L. Chiec, D.S. Bruno (2024)

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