Current approach to malignant mesothelioma of the pleura

Our plain-English summary of Current approach to malignant mesothelioma of the pleura, by J. Aisner (Chest, 1995).

The study

• Author: J. Aisner
• Journal: Chest
• Published: 1995;107(6 Suppl):332S-344S
• Type of article: Review
• Cited by: 88 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma of the pleura occurs primarily in individuals who were exposed to asbestos either in the workplace or home. The incidence of malignant mesothelioma is rising and, reflective of the malignancy's long latency period, is expected to continue to increase into the next century. Current treatment measures, including surgery, radiation therapy, chemotherapy, intrapleural therapy, and combined-modality therapies, have had varying impacts on survival. This paper explores current trends in the treatment of malignant pleural mesothelioma.

In plain English

This narrative review, not a new study, surveyed published reports on treating malignant pleural mesothelioma, which the author noted occurs mainly in people exposed to asbestos at work or home. Its figures came from other researchers' studies; the author described the University of Maryland group's own results only as similar to another group's. Pleurectomy studies reported median survival of 6.7 to 21 months, and extrapleural pneumonectomy reports 4 to 21 months. Early extrapleural pneumonectomy reports gave postoperative death rates as high as 31%; the author wrote that recent studies had brought these below 5%, though two recent series cited had rates of 15% and 5%. Most reviews of radiation therapy had found no significant effect on disease control or survival. One study of gamma interferon given into the pleural space reported a 24% total response rate among 99 patients with early-stage disease. The author wrote that differences in patients and patient selection prevented direct comparison of surgery with the disease's natural course. The author concluded that identifying at-risk patients early would help define better treatment options.

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: Narrative review by a single author of published literature on malignant pleural mesothelioma (epidemiology, diagnosis, staging and treatment), published in a conference supplement
• Who was studied: No new patients were studied. The review summarized published reports and trials on patients with malignant pleural mesothelioma treated with surgery, radiation, chemotherapy, intrapleural therapy and combined treatments. It also briefly mentioned the author's group's experience at the University of Maryland Cancer Center, without patient numbers.
• Exposure: Not an exposure study. The review covered treatments (surgery, radiation therapy, chemotherapy, intrapleural therapy, combined-modality therapy). Its background noted that the disease occurs primarily in people exposed to asbestos at work or at home.
• Main results:
  • Published pleurectomy studies by other researchers reported median survivals of 6.7 to 21 months
  • Published extrapleural pneumonectomy reports by other researchers gave median survival of 4 to 21 months
  • Early extrapleural pneumonectomy studies reported postoperative mortality as high as 31%
  • The author wrote that, with increasing experience, more recent studies had reduced operative and postoperative mortality to below 5%
  • In the two recent extrapleural pneumonectomy series the author highlighted, surgical mortality was 15% (Rusch et al, 20 patients) and 5% (Sugarbaker et al)
  • Most earlier reviews of radiation therapy concluded it had no significant effect on disease control or survival
  • Doxorubicin, described as probably the most extensively studied single drug, had a composite response rate of 16% across published studies
  • A study of high-dose methotrexate by Solheim et al reported a 37% response rate among 60 assessable patients
  • A study of intrapleural recombinant gamma interferon by Boutin et al reported a total response rate of 24% and a complete response rate of 7% among 99 patients with early-stage disease
  • At the University of Maryland Cancer Center, the author's group added radiation boosts to the surgical scar and needle tracts after extrapleural pneumonectomy and, recently, cisplatin instilled into the cavity. The author described the group's results as similar to Sugarbaker et al's, in whose series 45% of patients who had resection and no mediastinal lymph node involvement were alive at 2 years. No separate figures were given for the Maryland patients.
• The authors' conclusion: The author concluded that some at-risk patients can be identified on the basis of asbestos exposure. In the author's view, identifying at-risk patients early for specific therapy, and avoiding sclerosis, would help define better treatment options.
• Limitations the authors state:
  • The author stated that surgery could not be compared directly with the natural course of the disease, because the disease varies between patients and studies used different patient selection criteria
  • The author stated that combining small chemotherapy series into overviews carried a possible bias toward publishing positive results
  • The author stated that experience with combined-modality therapies was limited and that results could not be compared across studies

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleura, Latency, Chemotherapy, Pleural Mesothelioma.

Related studies

• Current surgical strategies for malignant pleural mesothelioma — T. Takuwa, S. Hasegawa (2016)
• Clinicopathologic studies on mesothelioma of the pleura. Differentiated approach to treatment — S. Larsson, B.M. Philipson, et al. (1988)
• 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)
• Current issues in malignant pleural mesothelioma evaluation and management — J. Ai, J.P. Stevenson (2014)
• Clinical features and current treatment of diffuse malignant pleural mesothelioma — V.W. Rusch (1995)
• Current controversies regarding the role of asbestos exposure in the causation of malignant mesothelioma: the need for an evidence-based approach to develop medicolegal guidelines — A.M. Marchevsky, M.R. Wick (2003)

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