Discussion

Our plain-English summary of Discussion, by D. Rice, D. Sugarbaker, R. Flores, et al (The Journal of Thoracic and Cardiovascular Surgery, 2016).

The study

• Authors: D. Rice, D. Sugarbaker, R. Flores, D. Harpole, V. Rusch
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2016;151(2):473-5
• Type of article: Comment
• Read it: PubMed · Publisher

In plain English

This item is the published transcript of the question-and-answer discussion after a presentation by de Perrot and colleagues at an American Association for Thoracic Surgery meeting. It is not a study in itself. The presented work concerned patients with malignant pleural mesothelioma who received short-course radiation to one side of the chest and then extrapleural pneumonectomy (removal of the lung and its lining). In the discussion, the presenting author said the radiation was 25 to 30 Gy in 5 fractions. No patient was opened and left unresected. About 24% of patients seen in the clinic entered the trial. No long-term radiation side effects had been seen so far, and pathology showed no downstaging. Dr Rice cited a median survival of 36 months. Dr Sugarbaker and Dr Flores questioned how patients were selected. Dr Flores noted there were only 62 patients and called a zero unresectability rate a red flag. Dr Rusch said the approach was not yet exportable beyond highly experienced centers and must still be considered investigational. Asbestos exposure was not discussed.

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: Published transcript of discussion (questions from surgeons and replies from the presenting author) following a conference presentation; not an original study
• Who was studied: The discussion concerned the presenting group's series of patients with malignant pleural mesothelioma treated at their institution over about 7 years; a discussant gave the number as 62 patients
• Exposure: No asbestos exposure was discussed. The subject was a treatment: short-course hemithoracic radiation given before extrapleural pneumonectomy
• Main results:
  • The presenting author said the radiation dose was 25 to 30 Gy in 5 fractions, corresponding to about 45 to 48 Gy given in a more standard way
  • The presenting author said no long-term radiation side effects had been seen so far, but that close monitoring was needed
  • Dr Rice cited a median survival of 36 months in the presented series
  • The presenting author said no patient was opened and left unresected, and that about 24% of patients seen in the clinic were included in the trial
  • The presenting author said surgery took place about 6 days after radiation ended, and pathology showed no downstaging
  • The presenting author said all patients are now staged with EBUS in addition to CT and PET scan
  • The presenting author said biphasic disease is currently not included in the protocol
  • Dr Rusch noted that disease progression in the presented patients was primarily at distant sites, similar to other series of EPP plus adjuvant hemithoracic radiation
• The authors' conclusion: Dr Rusch, a discussant, said the approach is not yet exportable beyond highly experienced centers and must still be considered investigational
• Limitations the authors state:
  • Dr Flores cautioned that the series was small and that a zero unresectability rate raises concern
  • The presenting author agreed the patients were a selected group
  • The presenting author said it was too early to judge the long-term effect of the trial

Topics

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

Related studies

• Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma — M. de Perrot, R. Feld, et al. (2016)
• SMART or simply bold? — V.W. Rusch, A. Rimner, et al. (2016)
• Discussion — (2015)
• Mesothelioma at era of helical tomotherapy: results of two institutions in combining chemotherapy, surgery and radiotherapy — A. Sylvestre, M.A. Mahé, et al. (2011)
• Recurrence of malignant pleural mesothelioma at the resection borders--local or distant recurrence? — D. Gomez, A. Tsao, et al. (2013)
• 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)

Browse more research in The Journal of Thoracic and Cardiovascular Surgery, or return to medical research.