In reply to L. Ceresoli et al. "Adjuvant radiotherapy for malignant pleural mesothelioma: challenges and pitfalls"

Our plain-English summary of In reply to L. Ceresoli et al. "Adjuvant radiotherapy for malignant pleural mesothelioma: challenges and pitfalls", by S. Tonoli, S. Magrini, G. Tassi (Radiotherapy and Oncology, 2012).

The study

• Authors: S. Tonoli, S. Magrini, G. Tassi
• Journal: Radiotherapy and Oncology
• Published: 2012;105(2):272
• Type of article: Letter, Comment
• Read it: PubMed · Publisher

In plain English

This is a letter to the editor in which the authors replied to comments by Ceresoli and colleagues on the authors' earlier paper about radiotherapy after surgery for malignant pleural mesothelioma. It reports no new study and does not discuss asbestos exposure. The authors explained that their paper described all patients treated consecutively with radiotherapy after extrapleural pneumonectomy, with or without chemotherapy, in three radiation oncology departments. They described this as a selected group that was not uniform in its overall treatment. Of the 56 patients, 34 (60.7%) had pathologic stage III disease, 10 (17.9%) had stage IV, 25 had cancer in nearby lymph nodes, and 20 had positive surgical margins. Overall survival was 60% plus or minus 7% at 3 years and 50% plus or minus 7% at 5 years, with no significant differences by pathological stage. The authors concluded that this, in their opinion, justified continuing radiotherapy for this selected group. They also wrote that after the MARS trial, which they called questionable, the number of these operations at their institution fell sharply.

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: Letter to the editor (authors' reply) giving further detail on the authors' previously published case series of consecutively treated patients
• Who was studied: 56 patients with malignant pleural mesothelioma treated consecutively with adjuvant radiotherapy after extrapleural pneumonectomy in three radiation oncology departments; median age 57.8 years; time period not stated in the letter
• Exposure: No asbestos exposure is reported. The treatment described was adjuvant radiotherapy after extrapleural pneumonectomy, with or without chemotherapy. 15 patients received no chemotherapy. 18 of the 20 patients with positive margins received a simultaneous integrated boost of 60 Gy in 25 fractions.
• Main results:
  • Pathologic stage among the 56 patients: stage III in 34/56 (60.7%) and stage IV in 10 (17.9%)
  • Loco-regional lymph nodes were positive for metastasis in 25/56 patients (44.6%)
  • 20 of the 56 patients had positive surgical margins
  • Karnofsky performance index: 70 in 7 patients (12.5%), 80 in 35 (62.5%), 90 in 12 (21.4%) and 100 in 2 (3.6%)
  • Overall survival in this population was 60 plus or minus 7% at 3 years and 50 plus or minus 7% at 5 years, without significant differences by pathological stage
  • Three referred patients were not treated with radiotherapy: one because of severe postoperative shortness of breath and two because of protracted surgical complications
• The authors' conclusion: The authors considered that these survival results justified, in their opinion, continuing to treat this selected group of patients with radiotherapy and modern techniques. They also stated that after the MARS trial, which they called questionable, the number of patients undergoing extrapleural pneumonectomy at their institution fell dramatically.
• Limitations the authors state:
  • The patients were a selected group: those judged inoperable from the start and given palliative chemotherapy alone were seen about twice as often as those who had surgery and radiotherapy
  • Patients had surgery at different institutions under different protocols, especially for chemotherapy, so the group was not homogeneous in its overall treatment

Topics

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

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

Related studies

• Adjuvant radiotherapy for malignant pleural mesothelioma: challenges and pitfalls — G.L. Ceresoli, U. Ricardi, et al. (2012)
• Adjuvant radiotherapy after extrapleural pneumonectomy for mesothelioma. Prospective analysis of a multi-institutional series — S. Tonoli, P. Vitali, et al. (2011)
• Induction chemotherapy, extrapleural pneumonectomy, and adjuvant radiotherapy for malignant pleural mesothelioma: experience of Guy's and St Thomas' hospitals — A. Bille, E. Belcher, et al. (2012)
• Hemithoracic radiotherapy for mesothelioma: lack of benefit or lack of statistical power? - Authors' reply — O. Riesterer, W. Weder, et al. (2016)
• The Role of Adjuvant Radiotherapy in the Treatment of Pleural Mesothelioma — G.D. Lewis, S.M. Dalwadi, et al. (2019)
• Pattern of failure after adjuvant radiotherapy following extrapleural pneumonectomy of pleural mesothelioma in the SAKK 17/04 trial — O. Riesterer, I.F. Ciernik, et al. (2019)

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