Malignant mesothelioma. Current status and future prospects

Our plain-English summary of Malignant mesothelioma. Current status and future prospects, by J. Aisner, P.H. Wiernik (Chest, 1978).

The study

• Authors: J. Aisner, P.H. Wiernik
• Journal: Chest
• Published: 1978;74(4):438-44
• Type of article: Review
• Cited by: 69 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002108).

In plain English

This article was a critical review of information on malignant mesothelioma: its pathology, symptoms, X-ray findings, link with asbestos exposure, and treatment. It presented no patient study of its own; it reviewed other investigators' data, including unpublished treatment results cited as a personal communication. Citing earlier research, the authors noted a suggested latent period of 20 to 40 years between asbestos exposure and the tumor. They reported that no prospective studies compared surgery with no treatment, although surgically treated patients appeared to outlive earlier, less aggressively treated patients. More radical surgery (pleuropneumonectomy) had not shown an advantage. External-beam radiotherapy alone was described as useful for relieving symptoms but not for prolonging survival. Reports on radioactive gold placed in the pleural space were described as largely anecdotal. Doxorubicin appeared to be an active drug, and alkylating agents such as cyclophosphamide showed some activity. It was unclear whether any drug combination worked better than single drugs. The authors noted that past studies involved small numbers of patients. They proposed early-detection programs in high-risk groups such as asbestos-exposed industrial workers, larger cooperative treatment trials, and combining local with systemic therapy.

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: critical review of the literature
• Who was studied: No patient study of the authors' own; the review covered other investigators' reports on malignant mesothelioma (pleural and peritoneal) up to 1978, including unpublished combination-chemotherapy results from L. H. Baker and R. S. Benjamin cited as a personal communication in Table 2
• Exposure: Asbestos exposure in general, as discussed in the reviewed literature; the review itself did not measure exposure or analyze specific fiber types
• Main results:
  • Summarizing the literature, the review stated that epidemiologic data suggested a latent period of 20 to 40 years from asbestos exposure to the emergence of the tumor
  • No prospective studies compared surgery with no treatment or other therapies, but in the reviewed reports surgically treated patients appeared to survive longer than past patients treated less aggressively
  • More radical surgery, in particular pleuropneumonectomy, had not shown an advantage in the reviewed studies
  • Studies from major centers found external-beam radiotherapy alone useful for palliation but ineffective in prolonging survival
  • Encouraging reports on instillation of radioactive colloidal gold were largely anecdotal
  • Among single drugs, doxorubicin (adriamycin) appeared to be an active compound, and the alkylating agents, in particular cyclophosphamide, had some activity
  • It was unclear which drug combination, if any, was more effective than single drugs used to date
  • The authors proposed early-detection programs using epidemiologic data to survey groups expected to be at high risk, for example industrial workers exposed to asbestos
• The authors' conclusion: The authors concluded that one desirable approach to treating this tumor would be to combine a localized therapy (such as pleurectomy or instillation of radioactive compounds) with systemic chemotherapy, tested in prospective studies
• Limitations the authors state:
  • The authors stated that the main difficulty in evaluating past studies was the small number of patients treated by any one method, and that larger cooperative groups were needed to enroll enough patients
  • The authors stated that no prospective studies compared surgery with no treatment or with alternative therapies

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.

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