Commentary: Surgeon versus mesothelioma in a thoracic cage match

Our plain-English summary of Commentary: Surgeon versus mesothelioma in a thoracic cage match, by C.D. Hoang (The Journal of Thoracic and Cardiovascular Surgery, 2020).

The study

• Author: C.D. Hoang
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2020;159(6):2522-2523
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher

In plain English

This is a short commentary, not an original study. The author, from the Thoracic Surgery Branch of the National Cancer Institute, discussed a separate study by Burt and colleagues. That study looked at how to predict, before surgery, which patients with malignant pleural mesothelioma (MPM) could not have their tumor removed. As the commentary describes it, the Burt study looked back at preoperative chest CT scans and calculated the volume of each side of the chest, called thoracic cage volume (TCV). In a subgroup of 24 patients found during surgery to have diffuse chest wall invasion by tumor, a TCV decrease of more than 5% on the tumor side was closely associated with that invasion. The author noted that the method does not assess tumor spread into the diaphragm, the mediastinum, or major structures such as the aorta. The author said larger, prospectively designed studies would show whether TCV is truly accurate in prediction. The author suggested TCV could be a useful addition to routine imaging. 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 (editorial discussion) on another published study (Burt and colleagues, 'Preoperative prediction of unresectability in malignant pleural mesothelioma'); no original data
• Main results:
  • The commentary reports that, in the Burt and colleagues study (not this article), among a subgroup of 24 patients with diffuse chest wall invasion found during curative-intent surgery, a decrease of more than 5% in thoracic cage volume on the tumor side was closely associated with that invasion
  • The commentary describes the Burt and colleagues analysis as retrospective, with thoracic cage volume calculated from preoperative chest CT scans
• The authors' conclusion: The author concluded that a relatively decreased volume of one side of the chest on CT is associated with extensive chest wall invasion by mesothelioma and suggests the tumor cannot be removed. The author also suggested that TCV could become a useful preoperative measure alongside routine imaging.
• Limitations the authors state:
  • The commentary author noted that the Burt and colleagues technique does not explicitly assess tumor involvement of the diaphragm, mediastinum, or major thoracic structures such as the aorta
  • The commentary author stated that a prospectively designed study is needed to determine whether TCV is truly accurate in preoperative prediction

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: Mesothelioma.

Related studies

• Commentary: Is thoracic cage volume a new parameter for clinical staging in mesothelioma? — M. de Perrot (2020)
• The 2019 ERS/ESTS/EACTS/ESTRO Guidelines on the Management of Patients With Malignant Pleural Mesothelioma — T.A. Gelzinis (2021)
• Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma — A. Scherpereel, P. Astoul, et al. (2010)
• Malignant pleural mesothelioma and the Society of Thoracic Surgeons Database: an analysis of surgical morbidity and mortality — B.M. Burt, R.B. Cameron, et al. (2014)
• A survey of opinions and beliefs concerning surgery for malignant pleural mesothelioma amongst 802 members of the European Association for Cardio-Thoracic Surgery (EACTS), the European Society of Thoracic Surgeons (ESTS) and the Society of Thoracic Surgeons (STS) — T. Treasure, E. Internullo, et al. (2011)
• PET scan contribution in chest tumor management: a systematic review for thoracic surgeons — L. Duranti, F. Leo, et al. (2012)

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