Letter to the Editor: Comment on 'Malignant pleural mesothelioma: Comparison of surgery-based trimodality therapy to medical therapy at two tertiary academic institutions'

Our plain-English summary of Letter to the Editor: Comment on 'Malignant pleural mesothelioma: Comparison of surgery-based trimodality therapy to medical therapy at two tertiary academic institutions' (Lung Cancer, 2021).

The study

• Journal: Lung Cancer
• Published: 2021;159:127
• Type of article: Letter
• Read it: PubMed · Publisher

In plain English

This is a letter to the editor, not an original study. Its authors commented on a published study by Larose and colleagues that compared surgery-based trimodality therapy with medical therapy for malignant pleural mesothelioma at two university hospitals, one in the U.K. and one in Canada. The letter's authors argued that the original study's conclusion of a possible survival benefit was an overestimation of the data. They noted that patients' performance score was missing, that the U.K. patients were a selected group referred to a specialized clinic, and that more than half of the Canadian patients received no treatment. By their reading of the original study, 104 of 106 U.K. patients received all three treatments, while 48 Canadian patients received at least one form of treatment. Because 58 U.K. patients were matched to 58 Canadian patients, they reasoned that at least 10 matched Canadian patients received no treatment. The authors concluded that missing prognostic factors made the claim of a substantial survival benefit unsustainable. They wrote that they awaited results of the MARS-2 trial.

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 commenting on another group's published study (no new data)
• Who was studied: No patients were studied by the letter's authors. The letter discusses the patients in Larose et al: a U.K. group referred to a specialized clinic for multimodality therapy and a Canadian cohort of consecutive patients referred to an oncology clinic, at two university hospitals.
• Exposure: Not an asbestos exposure study. The letter discusses treatment of malignant pleural mesothelioma: surgery-based trimodality therapy (cancer-directed surgery, systemic chemotherapy, prophylactic radiotherapy) compared with medical therapy.
• Main results:
  • The letter's authors noted that patients' performance score was missing from the original study, and argued that the U.K. patients, a selected population referred to a specialized clinic, likely had better overall performance status.
  • The letter's authors stated that more than half of the patients in the Canadian cohort did not receive any treatment.
  • According to the letter, in the English (U.K.) group 104 of 106 patients received all three treatment modalities, while in the Canadian group 50 patients received only palliative care.
  • According to the letter, in the Canadian group 30 patients received palliative chemotherapy, 9 received prophylactic radiotherapy on drain and port sites, and 9 received chemo- and radiotherapy, so 48 received at least one form of treatment.
  • In the propensity-matched analysis, 58 U.K. patients were compared to 58 Canadian patients. The letter's authors reasoned that at least 10 of these Canadian patients received no treatment at all.
  • The letter's authors said the original study did not describe the Canadian patient referral policy, which they said is open to selection bias.
• The authors' conclusion: The letter's authors considered the original study's conclusion an overestimation of the data. They said missing prognostic factors (performance score, and biomarkers such as Ki67) made the claimed survival benefit unsustainable, and wrote that they awaited the MARS-2 trial results on the effect of pleurectomy decortication.

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: Pleural Mesothelioma, Trimodality Therapy.

Related studies

• Malignant pleural mesothelioma: Comparison of surgery-based trimodality therapy to medical therapy at two tertiary academic institutions — F. Larose, N. Quigley, et al. (2021)
• Response to the "Letter to the Editor" by Gabor Mezei et al., Comments on Vimercati et al., 2019, "Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (Southern Italy) mesothelioma register" — L. Vimercati, D. Cavone, et al. (2019)
• Trimodality therapy for malignant pleural mesothelioma: results from an EORTC phase II multicentre trial — P.E. Van Schil, P. Baas, et al. (2010)
• Improved Outcomes with Modern Lung-Sparing Trimodality Therapy in Patients with Malignant Pleural Mesothelioma — F. Shaikh, M.G. Zauderer, et al. (2017)
• Miliary mesothelioma: a new clinical and radiological presentation in mesothelioma patients with prolonged survival after trimodality therapy — L. Purek, S. Laroumagne, et al. (2011)
• Mesothelioma at era of helical tomotherapy: results of two institutions in combining chemotherapy, surgery and radiotherapy — A. Sylvestre, M.A. Mahé, et al. (2011)

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