Commentary: Adjuvant intensity-modulated radiation therapy for malignant pleural mesothelioma: Suspension of intention

Our plain-English summary of Commentary: Adjuvant intensity-modulated radiation therapy for malignant pleural mesothelioma: Suspension of intention, by S.S. Groth, B.M. Burt, R.T. Ripley (The Journal of Thoracic and Cardiovascular Surgery, 2019).

The study

• Authors: S.S. Groth, B.M. Burt, R.T. Ripley
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2019;158(3):932-933
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher

In plain English

This is a short commentary, not a new study. The authors, thoracic surgeons at Baylor College of Medicine in Houston, discussed a separate study by Nelson and colleagues published in the same journal issue. That study reviewed 160 patients with malignant pleural mesothelioma treated at a single institution over 13 years with a three-part plan: platinum/pemetrexed chemotherapy before surgery, surgery (pleurectomy/decortication or extrapleural pneumonectomy), and intensity-modulated radiation therapy (IMRT) afterwards. According to the commentary, Nelson and colleagues found that other health conditions (an American Society of Anesthesiologists score of 3 or higher) and a smoking history independently predicted not completing the radiation. In that study, the type of surgery did not predict whether patients received IMRT. Patients with heart or lung complications after surgery were half as likely to complete IMRT as those without. The commentary does not discuss asbestos exposure. The authors concluded that careful patient selection is critical to completing all planned treatments. They suggested that better management of other diseases, rehabilitation and nutrition might improve IMRT completion among borderline surgical candidates, while noting that this is unknown.

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 on another study (Nelson and colleagues, a single-institution review of patients given trimodality therapy). The authors collected no new data.
• Who was studied: The study commented on (Nelson and colleagues) reviewed 160 patients with malignant pleural mesothelioma treated at a single institution over a 13-year period with trimodality therapy. The commentary does not name the institution or the years.
• Exposure: No asbestos exposure is discussed. The treatment studied was neoadjuvant platinum/pemetrexed chemotherapy, then pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP), then adjuvant intensity-modulated radiation therapy (IMRT).
• Main results:
  • As reported in the commentary, in the Nelson study other health conditions (an American Society of Anesthesiologists score of 3 or higher) and smoking history were independent predictors of not completing IMRT.
  • As reported in the commentary, in the Nelson study the type of surgery (P/D or EPP) did not predict whether patients received IMRT.
  • As reported in the commentary, in the Nelson study patients who had cardiopulmonary complications were half as likely to complete IMRT as patients who did not.
• The authors' conclusion: The authors concluded that careful patient selection is critical to maximizing the probability that all planned treatments are completed. They also suggested, while noting this is unknown, that optimizing medical management of systemic diseases, physical and respiratory rehabilitation, and improved nutrition might improve IMRT completion among borderline surgical candidates.

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: Intensity-Modulated Radiation Therapy (IMRT), Pleural Mesothelioma.

Related studies

• Adjuvant intensity-modulated proton therapy in malignant pleural mesothelioma. A comparison with intensity-modulated radiotherapy and a spot size variation assessment — S. Lorentini, M. Amichetti, et al. (2012)
• Patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesothelioma — D.R. Gomez, D.S. Hong, et al. (2013)
• Disease-Related Outcomes and Toxicities of Intensity Modulated Radiation Therapy After Lung-Sparing Pleurectomy for Malignant Pleural Mesothelioma: A Systematic Review — R. Patel, E.B. Ludmir, et al. (2020)
• Geometric dose prediction model for hemithoracic intensity-modulated radiation therapy in mesothelioma patients with two intact lungs — L. Kuo, E.D. Yorke, et al. (2016)
• Intensity-Modulated Radiation Therapy Improves the Target Coverage Over 3-D Planning While Meeting Lung Tolerance Doses for All Patients With Malignant Pleural Mesothelioma — S. Ulger, E. Cetin, et al. (2017)
• Current readings: improvements in intensity-modulated radiation therapy for malignant pleural mesothelioma — K.E. Rosenzweig (2013)

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