Commentary: Return to intended radiation therapy-Criteria for resection?

Our plain-English summary of Commentary: Return to intended radiation therapy-Criteria for resection?, by J. Dux, R. Grosser, P.S. Adusumilli (The Journal of Thoracic and Cardiovascular Surgery, 2019).

The study

• Authors: J. Dux, R. Grosser, P.S. Adusumilli
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2019;158(3):930-931
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher · Free full text

In plain English

This is a short commentary, not an original study. The authors discussed an article by Nelson and colleagues in the same issue. That study reviewed records of patients with malignant pleural mesothelioma who had surgery, to learn why some did not receive planned radiation. As the commentary reports, sixty-five percent of patients in the Nelson study completed radiation. In a multivariate analysis, smoking history and an American Society of Anesthesiologists (ASA) score above 3 were associated with lower chances of completing radiation (odds ratios 0.42 and 0.27, respectively). In a univariate analysis, heart or lung complications were associated with a 50% lower likelihood. Type of surgery made no significant difference in likelihood of completing radiation. Thirteen percent did not complete radiation because of bulky remaining or recurrent tumor. The commentators questioned how well the ASA score reflected patients' health and noted that performance status measures were missing. They argued that failing to complete radiation does not justify forgoing surgery. They also called for investigating combinations of existing and emerging therapies, such as immunotherapy. The article does 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: Invited commentary on another study (Nelson and colleagues, J Thorac Cardiovasc Surg 2019;158:924-9) published in the same issue; no new data
• Who was studied: The commented-on study (Nelson and colleagues) reviewed medical records of patients with malignant pleural mesothelioma who completed surgical resection; the commentary does not give the number of patients, place or dates
• Exposure: No asbestos or fiber exposure is discussed; the subject is treatment (surgical resection followed by planned radiation therapy) for malignant pleural mesothelioma
• Main results:
  • As reported in the commentary, sixty-five percent of patients in the Nelson study completed radiation therapy after surgery
  • In the Nelson study's multivariate analysis, smoking history and ASA score greater than 3 were associated with decreased probability of completing radiation therapy (odds ratios 0.42 and 0.27, respectively)
  • In the Nelson study's univariate analysis, cardiovascular or pulmonary complications were associated with a 50% decreased likelihood of completing radiation therapy
  • In the Nelson study, type of resection did not lead to significant differences in the likelihood of completing radiation therapy
  • In the Nelson study, 13% of patients did not complete radiation therapy because of bulky remaining or recurrent tumor
• The authors' conclusion: The commentators concluded that failure to complete radiation therapy does not justify forgoing surgery. They also concluded that rational combinations of existing and emerging therapies (such as immunotherapy) should be investigated in the management of malignant pleural mesothelioma
• Limitations the authors state:
  • The commentators noted that more than two-thirds of patients in the Nelson study had ASA scores greater than 3. They considered it unlikely that patients with severe systemic disease were selected for aggressive surgery, which they said shows the limitations of the ASA score
  • The commentators noted that the Nelson study did not include preoperative comorbidities or performance status measures (Karnofsky, Eastern Cooperative Oncology Group)
  • The commentators raised the possibility that patients with more comorbidities were selected for pleurectomy decortication rather than extrapleural pneumonectomy, which could have influenced the results

Topics

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

Related studies

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• Commentary: A return trip to MARS: Less may be more when treating mesothelioma — C.M. Griffin, V.H. van Berkel (2022)
• Commentary on pathologic diagnosis of asbestosis and critique of the 2010 Asbestosis Committee of the College of American Pathologists (CAP) and Pulmonary Pathology Society's (PPS) update on the diagnostic criteria for pathologic asbestosis — S.P. Hammar, J.L. Abraham (2015)
• Radiation-related occupational cancer and its recognition criteria in South Korea — S. Seo, D. Lee, et al. (2018)
• Radiation therapy in the management of patients with mesothelioma — W. Gordon, K.H. Antman, et al. (1982)
• A feasibility study evaluating Surgery for Mesothelioma After Radiation Therapy: the "SMART" approach for resectable malignant pleural mesothelioma — B.C. Cho, R. Feld, et al. (2014)

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