Commentary: Is thoracic cage volume a new parameter for clinical staging in mesothelioma?

Our plain-English summary of Commentary: Is thoracic cage volume a new parameter for clinical staging in mesothelioma?, by M. de Perrot (The Journal of Thoracic and Cardiovascular Surgery, 2020).

The study

• Author: M. de Perrot
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2020;159(6):2520-2521
• Type of article: Editorial, Comment
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article was a short commentary, not an original research study. Its author discussed a separate study by Burt and colleagues on predicting, before surgery, whether malignant pleural mesothelioma had spread diffusely into the chest wall. According to the commentary, Burt and colleagues used CT scans to measure three-dimensional thoracic cage volume (TCV) and compared how much it had shrunk on the affected side with the other side. The commentary reported that, in that study, reduced TCV was an independent predictor of diffuse chest wall invasion, possibly more accurate than MRI. Chest pain requiring opioids and lower lung blood flow on a ventilation-perfusion scan were also strong predictors, while clinical stage was not. The commentary's author noted that the study came from a single center, looked back at past cases, and did not assess survival, and that TCV may not be easily available in the clinic. The author concluded that TCV and tumor volume could help refine clinical staging of mesothelioma. The commentary did not discuss asbestos exposure.

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 published study (Burt and colleagues); no new data were collected or analyzed
• Who was studied: The commentary studied no patients itself. It discussed a single-center, retrospective study by Burt and colleagues of patients with malignant pleural mesothelioma being assessed for surgery. The commentary gives no patient numbers.
• Main results:
  • According to the commentary, Burt and colleagues observed that diffuse chest wall invasion was more frequent in patients whose chest wall had pulled inward on the tumor side. They developed a measure of three-dimensional thoracic cage volume from CT scans that compares the affected side with the other side.
  • The commentary reported that, in the Burt study, reduction in TCV was an independent predictor of diffuse chest wall invasion, with potentially better accuracy than magnetic resonance imaging.
  • The commentary reported that, in the Burt study, chest pain requiring opioids and lower perfusion on a ventilation-perfusion scan were also strong predictors of diffuse chest wall invasion, while clinical stage was not.
  • The commentary's author cited the author's own earlier experience in patients receiving accelerated hemithoracic radiation followed by extrapleural pneumonectomy. In those patients, opioid requirement and lung perfusion of less than 20% without pleural effusion helped reduce the rate of exploratory thoracotomy to 0%.
  • The commentary noted that Burt and colleagues did not assess survival.
• The authors' conclusion: The commentary's author concluded that the volume of the thoracic cavity on the tumor side and the tumor volume are two potential parameters that could help refine clinical staging of mesothelioma. The author expressed hope that this would lead to more accurate staging in the next edition of the TNM staging system.
• Limitations the authors state:
  • The commentary's author stated that the Burt study was limited by being a single-center, retrospective study.
  • The commentary's author stated that TCV may not be easily available in the clinic when treatment options are being discussed with patients.

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: Staging, Mesothelioma.

Related studies

• Commentary: Surgeon versus mesothelioma in a thoracic cage match — C.D. Hoang (2020)
• Volume-based parameter of 18)F-FDG PET/CT in malignant pleural mesothelioma: prediction of therapeutic response and prognostic implications — H.Y. Lee, S.H. Hyun, et al. (2010)
• Prognostic value of pretreatment volume-based quantitative 18F-FDG PET/CT parameters in patients with malignant pleural mesothelioma — K. Kitajima, H. Doi, et al. (2017)
• Diagnostic accuracy of sequential co-registered PET+MR in comparison to PET/CT in local thoracic staging of malignant pleural mesothelioma — K. Martini, A. Meier, et al. (2016)
• Eighth Edition Staging of Thoracic Malignancies: Implications for the Reporting Pathologist — A.G. Nicholson, M.S. Tsao, et al. (2018)
• Radiologic Considerations and Standardization of Malignant Pleural Mesothelioma Imaging Within Clinical Trials: Consensus Statement from the NCI Thoracic Malignancy Steering Committee - International Association for the Study of Lung Cancer - Mesothelioma Applied Research Foundation Clinical Trials Planning Meeting — R.R. Gill, A.S. Tsao, et al. (2019)

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