Comprehensive treatment of malignant mesothelioma patients after the failure of systemic chemotherapy

Our plain-English summary of Comprehensive treatment of malignant mesothelioma patients after the failure of systemic chemotherapy, by J. Chen, B. Liang, Y. Yuan, et al (Cryobiology, 2012).

The study

• Authors: J. Chen, B. Liang, Y. Yuan, C. Liu, L. Li, H. Li, F. Mu, J. Zuo, K. Xu
• Journal: Cryobiology
• Published: 2012;65(3):284-8
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma (MM) is an aggressive neoplasm usually arising from the mesothelial surfaces of the pleural or peritoneal cavity. Currently, no standard therapy is available. The most commonly used therapy is cytoreductive surgery combined with systematic chemotherapy, but the median overall survival (OS) is less than 12 months; moreover, treatments are lacking for patients in whom chemotherapy has failed and/or who cannot withstand surgery. We investigated multiple minimally invasive therapies (cryosurgery, photodynamic therapy and intracavity chemotherapy) for the treatment of MM patients in whom systemic chemotherapy had failed. Twenty-seven patients were divided into comprehensive (combination of the three therapies) and palliative (intracavity chemotherapy only) treatment groups. The OS of patients who received comprehensive treatment was significantly longer than that of those who received palliative treatment (median OS: 64 vs. 9 months, P<0.001). This interesting result was not associated with treatment timing, but was closely associated with repeated treatments.

Copyright © 2012 Elsevier Inc. All rights reserved.

In plain English

This retrospective study from Fuda Hospital in Guangzhou, China, looked at 27 patients with pleural or diffuse peritoneal malignant mesothelioma treated between September 2003 and January 2012. All had tumors judged unresectable and had already had systemic chemotherapy that failed. According to their own wishes, patients received either 'comprehensive' treatment (cryosurgery, photodynamic therapy and heated cisplatin chemotherapy delivered into the chest or abdominal cavity) or 'palliative' treatment (the cavity chemotherapy alone). The results section reports 18 comprehensive and 9 palliative patients, although the methods section gives 15 and 12. Median overall survival, counted from diagnosis, was 64 months in the comprehensive group and 9 months in the palliative group (P less than 0.001). The time between chemotherapy and later treatment showed no obvious link with survival. In both groups, patients treated more than once had longer median survival than those treated once: 81.5 versus 38 months with comprehensive treatment, and 26.5 versus 7 months with palliative treatment. No severe complications or treatment-related deaths were reported. The authors concluded that survival was associated with repeated treatments, not timing. The study did not examine 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: Retrospective study comparing two treatment groups at a single hospital
• Who was studied: 27 patients with malignant pleural mesothelioma (MPM) or diffuse malignant peritoneal mesothelioma (DMPM) treated at a cancer hospital in Guangzhou, China, from September 2003 to January 2012. Their tumors were considered unresectable and systemic chemotherapy had failed. The results section reports 18 comprehensive-treatment patients (12 MPM, 6 DMPM) and 9 palliative-treatment patients (6 MPM, 3 DMPM), from China and other countries.
• Exposure: No asbestos exposure was studied. The comparison was between treatments: cryosurgery plus photodynamic therapy plus intracavity hyperthermal cisplatin perfusion chemotherapy (comprehensive group), versus intracavity chemotherapy only (palliative group), given after failure of systemic chemotherapy.
• Main results:
  • Median overall survival was 64 months in the comprehensive treatment group and 9 months in the palliative treatment group; the difference was statistically significant by log-rank test (P less than 0.001).
  • For all 27 patients, median overall survival was 41 months (25th percentile 22 months; 75th percentile 86 months). All 27 patients died before July 2012.
  • Treatment timing: in the comprehensive group, median survival was 69 months when treated less than 1 year after systemic chemotherapy and 52 months when treated later (P = 0.2033). In the palliative group the figures were 9 and 14.5 months (P = 0.6079). The authors found no obvious correlation between survival and treatment interval in either group.
  • Repeated treatment, comprehensive group: median survival was 81.5 months with multiple treatments (12 patients) versus 38 months with a single treatment (6 patients), P = 0.0403.
  • Repeated treatment, palliative group: median survival was 26.5 months with multiple treatments (4 patients) versus 7 months with a single treatment (5 patients), P = 0.037.
  • There were no severe complications and no treatment-related deaths. In the comprehensive group, side effects included pneumothorax in 4 patients (reported as 33%), slight wound bleeding in 7 (39%) and chest pain in 7 (39%), all resolving within 8 to 13 days without treatment. No adverse effects were reported in the palliative group.
  • Within 1 week of the first treatment, 14 comprehensive-group patients (78%) and 6 palliative-group patients (67%) had a reduction in pain score of at least 50%.
• The authors' conclusion: The authors concluded that comprehensive treatment was associated with significantly longer survival than palliative treatment, and that this was not associated with treatment timing but was closely associated with repeated treatments. They also stated that, on the evidence available, initial cytoreductive surgery with perioperative intracavity chemotherapy still achieves the longest survival.
• Limitations the authors state:
  • The authors stated that data on newly diagnosed patients who skip systemic chemotherapy are currently insufficient for analysis, and that further data are needed.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Chemotherapy, Neoplasm, Peritoneal Cavity, Cytoreductive Surgery, Median Overall Survival, Palliative Care.

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