Conventional treatment and its effect on survival of malignant pleural mesothelioma in Western Australia

Our plain-English summary of Conventional treatment and its effect on survival of malignant pleural mesothelioma in Western Australia, by A.W. Musk, S.D. Woodward (Australian and New Zealand Journal of Medicine, 1982).

The study

• Authors: A.W. Musk, S.D. Woodward
• Journal: Australian and New Zealand Journal of Medicine
• Published: 1982;12(3):229-32
• Cited by: 26 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000697).

Abstract

Analysis of the survival of all 81 cases of pathologically confirmed malignant pleural mesothelioma in Western Australia between January 1957 and December 1980 has revealed a median survival from diagnosis of 5.1 months (mean 7.8 months). The average time between presentation and diagnosis was 3.4 months. Survival was better in younger subjects and subjects selected for surgery but was unrelated to sex, symptoms at onset, history of asbestos exposure, tumour morphology, therapy other than surgery or year of presentation. The selection of subjects at earlier clinical stages for surgical intervention is considered to account for their longer survival. The outlook for patients with this disease remains poor and there is still no optimism for future advances in therapy.

In plain English

This study looked back at the records of all 81 known patients in Western Australia with malignant pleural mesothelioma confirmed by tissue examination between January 1957 and December 1980 (73 men and 8 women). The authors examined how long the patients lived after diagnosis and whether treatment made a difference. Of the 81, 44 had been exposed to crocidolite asbestos from Wittenoom Gorge, 18 had other known asbestos exposure, and 19 had no known exposure. Median survival from diagnosis was 5.1 months and mean survival was 7.8 months, with some patients living up to 50 months. Patients younger than 56 lived longer than older patients. Survival was similar regardless of sex, source of asbestos exposure, side of the tumour, smoking, or year of presentation. Patients whose management included surgery lived longer than those given supportive care only, radiotherapy, or chemotherapy. The authors attributed this to fitter patients with earlier-stage disease being chosen for surgery. They found no evidence that radiotherapy prolonged life. They noted that disease stage could not be assessed reliably from the records.

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 review of survival in a case series of all known cases in one state
• Who was studied: 81 patients with histologically proven malignant pleural mesothelioma in Western Australia, January 1957 to 31 December 1980; 73 males and 8 females, aged 27-80
• Exposure: 44 patients had exposure to crocidolite from Wittenoom Gorge, 18 had other known past asbestos exposure, and 19 had no known asbestos exposure. Treatments compared were surgery, radiotherapy, chemotherapy, and supportive care only.
• Main results:
  • Median survival from diagnosis for the whole group was 5.1 months
  • Mean survival from diagnosis was 7.8 months; some patients survived up to 50 months
  • The mean time between first presentation and diagnosis was 3.4 months
  • Survival of the 73 males and 8 females was similar
  • Patients younger than 56 years survived longer than older patients (40 aged 27-55 vs 41 aged 56-80; p less than 0.01)
  • Patients exposed to Wittenoom crocidolite had survival similar to those with other asbestos exposure and those with no known exposure
  • The 47 patients with right-sided tumours had survival similar to the 34 with left-sided tumours
  • Patients with epithelial or biphasic tumours had slightly better survival than those with spindle or unspecified types, but this did not reach statistical significance
  • There was no evidence that patients presenting in more recent years survived longer, and survival of smokers and non-smokers did not differ
  • Patients whose management included surgery survived longer than those given supportive measures only, radiotherapy, or chemotherapy (p less than 0.05), independent of age and other recorded factors
  • The study provided no evidence supporting radiotherapy for prolonging life
• The authors' conclusion: The authors concluded that the poor outlook appeared unaffected by conventional treatment. They attributed the longer survival after surgery to the selection of fitter patients with earlier-stage disease for operation.
• Limitations the authors state:
  • Clinical stage at presentation could not be assessed accurately enough to analyse, because of the retrospective design and the number of clinicians involved
  • The pathology of the cases had not yet been reviewed by the mesothelioma register pathology panels
  • In some cases the histological type was not specified on the pathology report

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Median Survival, Asbestos Exposure.

Related studies

• Prevalence of radiographic asbestosis in crocidolite miners and millers at Wittenoom, Western Australia — W.O. Cookson, N.H. De Klerk, et al. (1986)
• Morphology of bronchogenic carcinoma in workers formerly exposed to crocidolite at Wittenoom Gorge in Western Australia — J.E. Baker, D.C. Reutens, et al. (1986)
• Effects of asbestos and smoking on the levels and rates of change of lung function in a crocidolite exposed cohort in Western Australia — H.S. Alfonso, L. Fritschi, et al. (2004)
• Plasma retinol, carotene and vitamin E concentrations and lung function in a crocidolite-exposed cohort from Wittenoom, Western Australia: a cohort study — H.S. Alfonso, L. Fritschi, et al. (2005)
• Plasma vitamin concentrations and incidence of mesothelioma and lung cancer in individuals exposed to crocidolite at Wittenoom, Western Australia — H.S. Alfonso, L. Fritschi, et al. (2006)
• Ultra-low-dose chest computer tomography screening of an asbestos-exposed population in Western Australia — F.J. Brims, C.P. Murray, et al. (2015)

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