Fifteen years in the evaluation of extrapleural pneumonectomy: Lessons to be learned

Our plain-English summary of Fifteen years in the evaluation of extrapleural pneumonectomy: Lessons to be learned, by T. Treasure, F. Macbeth (The Journal of Thoracic and Cardiovascular Surgery, 2015).

The study

• Authors: T. Treasure, F. Macbeth
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2015;149(5):1382-3
• Type of article: Editorial, Comment
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This editorial commentary, written in response to a related article in the same issue, reviewed 15 years of evaluating extrapleural pneumonectomy (EPP) for mesothelioma. The related study reported patterns of recurrence among 169 (38%) of 447 patients recorded as having had EPP in the Brigham and Women's Hospital (BWH) International Mesothelioma Program registry from 2001 to 2010. The remaining 62%, treated first with chemotherapy, were excluded. Median survival was 15 months for the EPP-first patients. The authors recalled a 1999 BWH report of 19 months median survival after trimodal therapy with EPP. They distinguished efficacy from effectiveness. They noted that EPP combined with intensity-modulated radiotherapy was associated with 10 months median survival, and EPP with heated intra-operative chemotherapy with 13 months. They argued that the appropriate comparator was not patients fit only for supportive care, who had 7 months median survival. They also argued that patient selection and immortal time bias confound such analyses. In the randomized MARS trial, patients assessed as suitable for EPP but assigned not to have it had a median survival of 19.5 months. The authors noted that the BWH study did not report quality of life. They cited evidence that EPP has a high complication rate and, in nonrandomized comparisons, gave poorer quality of life and shorter survival than lung-sparing surgery. They concluded that more multicenter randomized trials and independent analysis of all data were needed.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was an editorial commentary, not an original study. The authors commented on a separate Brigham and Women's Hospital (BWH) report on patients with mesothelioma who had extrapleural pneumonectomy (EPP), a major surgery. They noted that the BWH registry recorded 447 patients who had EPP from 2001 to 2010. The BWH report described recurrence in the 169 (38%) who had EPP first, with a median survival of 15 months in that group. It did not report quality of life. The authors argued that patients who receive EPP plus other treatments tend to start with a better outlook, which they said introduces immortal time bias. A fair comparison, in their view, needs similar patients, ideally a randomly assigned control group. They cited the MARS randomized trial, where patients judged suitable for EPP but assigned not to have it had a median survival of 19.5 months. They stated that there is no evidence EPP within combined treatment buys time, and that EPP is associated with a high rate of complications. The authors concluded that more impartially run, multicenter trials are needed.

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: Editorial commentary on a separately published study (no new data collected)
• Who was studied: No population of its own. The commentary discusses a Brigham and Women's Hospital International Mesothelioma Program registry study of 447 patients recorded as having extrapleural pneumonectomy from 2001 to 2010.
• Main results:
  • The authors reported that the BWH study they commented on described patterns of recurrence in 169 (38%) of the 447 patients, those who had undergone EPP first.
  • According to the authors, median survival in the BWH study was 15 months for the patients who had EPP first.
  • The authors noted that quality of life and other patient-reported outcomes were not reported in the BWH study.
  • The authors argued that patients who received multiple treatments had to have a better-than-average inherent prognosis, which they said introduces immortal time bias.
  • The authors cited the MARS randomized trial: patients assessed as suitable for EPP but randomly assigned not to have it had a median survival of 19.5 months.
  • The authors stated that EPP is associated with a high rate of complications.
  • The authors noted that only 2 randomized trials had been carried out in the 15 years they discussed.
• The authors' conclusion: The authors concluded that independent analysis of all the data is needed, along with multicenter trials that are impartially conducted, monitored and analyzed.

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: Extrapleural Pneumonectomy (EPP), Mesothelioma, Brigham and Women's Hospital, International Mesothelioma Program, Chemotherapy, Median Overall Survival, Intensity-Modulated Radiation Therapy (IMRT), Quality of Life.

Related studies

• Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma — M. de Perrot, R. Feld, et al. (2016)
• Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial) — S. Hasegawa, M. Okada, et al. (2016)
• Clinical and pathological features of three-year survivors of malignant pleural mesothelioma following extrapleural pneumonectomy — D.J. Sugarbaker, A.S. Wolf, et al. (2011)
• Multimodal treatment for malignant pleural mesothelioma — R.C. Rintoul, T. Treasure, et al. (2015)
• PI3K/mTOR signaling in mesothelioma patients treated with induction chemotherapy followed by extrapleural pneumonectomy — B.K. Bitanihirwe, M. Meerang, et al. (2014)
• The recurrence of malignant pleural mesothelioma 14 years after extrapleural pneumonectomy: possible histological transformation — T. Kinoshita, G. Ishii, et al. (2012)

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