Commentary: A journey of a thousand miles begins with a single step

Our plain-English summary of Commentary: A journey of a thousand miles begins with a single step, by T.F. Chen-Yoshikawa (The Journal of Thoracic and Cardiovascular Surgery, 2020).

The study

• Author: T.F. Chen-Yoshikawa
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2020;159(5):2092-2093
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher

In plain English

This short commentary, by an author at Nagoya University in Japan, discusses a separate study by de Perrot and colleagues published in the same journal. The commentary reports no new data of its own and does not discuss asbestos. It described the SMART protocol (Surgery for Mesothelioma After Radiation Therapy) for patients with malignant pleural mesothelioma: 25 Gy to 30 Gy of radiation to one side of the chest, given in 5 fractions, followed within 1 week by extrapleural pneumonectomy surgery. According to the commentary, de Perrot and colleagues found that CD8-positive tumor-infiltrating lymphocytes, a type of immune cell found in the tumor, independently predicted better survival in patients with epithelioid mesothelioma. These cells showed no such association in nonepithelioid mesothelioma. In patients undergoing SMART, the cells were also lower after preoperative radiation than after induction chemotherapy. Those researchers said further research was needed to confirm their findings. The author concluded that preoperative hypofractionated radiation might prime the immune system and potentially contribute to the benefits of multimodality treatment, and that the best immunotherapy targets remain to be determined.

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: Commentary (opinion piece) on another study, by de Perrot and colleagues, published in the same journal; no original data
• Who was studied: The commentary studied no population itself. The study it discusses involved patients with malignant pleural mesothelioma treated under the SMART protocol. The commentary gives no patient numbers.
• Exposure: No asbestos exposure is discussed. The treatment discussed is the SMART protocol: hemithoracic hypofractionated radiation of 25 Gy to 30 Gy in 5 fractions, followed by extrapleural pneumonectomy within 1 week.
• Main results:
  • As reported by the commentary (a finding of de Perrot and colleagues, not of this commentary): CD8-positive tumor-infiltrating lymphocytes were independent predictors of improved survival in patients with epithelioid malignant pleural mesothelioma.
  • As reported by the commentary (a finding of de Perrot and colleagues): CD8-positive tumor-infiltrating lymphocytes showed no such association with survival in patients with nonepithelioid malignant pleural mesothelioma.
  • As reported by the commentary (a finding of de Perrot and colleagues): in patients undergoing SMART, CD8-positive tumor-infiltrating lymphocytes were lower after preoperative radiation than after induction chemotherapy.
• The authors' conclusion: The author concluded that preoperative hypofractionated radiation might prime the immune system and potentially contribute to the benefits of multimodality treatment for malignant pleural mesothelioma. The author also stated that the optimal immunotherapy targets remain to be determined.
• Limitations the authors state:
  • The commentary reports that de Perrot and colleagues said their findings cannot be confirmed without further research, for example into the role of interferon in response to hypofractionated radiation.
  • The author states that the optimal immunotherapy targets are not yet known.

Topics

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

Related studies

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• Commentary: The role of single nucleotide polymorphisms related to iron homeostasis in mesothelioma susceptibility after asbestos exposure: a genetic study on autoptic samples — G. Tagarakis, F. Tsolaki, et al. (2024)
• Commentary: Not only SMART clinically, but translationally! — H.I. Pass (2020)
• The journey of mesothelioma: from postmortem to FNA — M. Gorecka, J. Scott, et al. (2014)
• Trabectedin in Malignant Pleural Mesothelioma: Results From the Multicentre, Single Arm, Phase II ATREUS Study — D. Cortinovis, F. Grosso, et al. (2021)
• The role of single nucleotide polymorphisms related to iron homeostasis in mesothelioma susceptibility after asbestos exposure: a genetic study on autoptic samples — P. Grignani, S.D. Visonà, et al. (2023)

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