Malignant mesothelioma of the pleura. A prospective therapeutic study of 132 patients from 1981-1985

Our plain-English summary of Malignant mesothelioma of the pleura. A prospective therapeutic study of 132 patients from 1981-1985, by A. Calavrezos, G. Koschel, H. Hüsselmann, et al (Klinische Wochenschrift, 1988).

The study

• Authors: A. Calavrezos, G. Koschel, H. Hüsselmann, A. Taylessani, H.P. Heilmann, H. Fabel, H.J. Schmoll, H. Dietrich, E. Hain
• Journal: Klinische Wochenschrift
• Published: 1988;66(14):607-13
• Cited by: 53 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. 000197).

Abstract

Between March 1981 and February 1985, 93 out of 132 patients with a histologically confirmed diagnosis of malignant pleural mesothelioma were eligible for therapy and were prospectively assigned to receive either combined therapy or best supportive care, according to their personal preferences. Fifty-seven patients underwent multimodal therapy including surgical resection where possible, polychemotherapy, and radiation therapy in case of partial remission. Thirty-six patients received maximal supportive care only, as did 39 patients who were not eligible for treatment. The median survival was 13 months for treated patients compared to 7 for those receiving best supportive care and 5 for patients not amenable to treatment. Median progress-free survival was 6, 2, and 1 month respectively. Surgical resection did not prolong life expectancy within the treated group. In view of significant differences in the distribution of various cofactors over the two study groups, stepwise Cox model analyses were performed. Prognostic nontreatment variables related to prolonged survival were: good performance status, stage I and II, absence of chest pain, age below 50 years, and epithelial histology. Although in the Cox model analyses the survival improvement of patients being treated could be greatly attributed to other cofactors, multimodal treatment showed some prolongation of life expectancy.

In plain English

This was a prospective study of 132 patients with histologically confirmed malignant pleural mesothelioma, registered between March 1981 and February 1985. Of these patients, 93 were eligible for treatment and were not randomized. Instead they were assigned by their own preference. Fifty-seven received combined therapy: surgery where possible, chemotherapy, and radiation in some cases. Thirty-six received best supportive care only. The 39 ineligible patients, mostly excluded because of age, also received supportive care. Median survival was 13 months with combined therapy, 7 months with supportive care, and 5 months for ineligible patients. The groups differed in age, performance status, histology and operability. After the authors adjusted for these factors, treatment showed only marginal significance (P = 0.03). Surgery showed no survival advantage within the treated group. Longer survival was associated with good performance status, stage I or II disease, no chest pain, age below 50, and epithelial histology. The authors concluded that multimodal treatment showed some prolongation of life expectancy. Of the 132 patients, 103 were recorded as asbestos-exposed.

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: Prospective, non-randomized therapeutic study comparing combined (multimodal) therapy with best supportive care, with patients assigned by their own preference; survival analysed with Kaplan-Meier, log-rank tests and stepwise Cox regression
• Who was studied: 132 consecutively registered patients with histologically confirmed malignant pleural mesothelioma, studied March 1981 to February 1985 with follow-up to December 1986. 93 were eligible (57 in combined therapy group A, 36 in best supportive care group B). 39 were not eligible (group NE), generally because of old age. The article does not state where patients were recruited, though the authors note that many mesotheliomas had been diagnosed in the Hamburg region.
• Exposure: The study compared treatments. Group A received surgical resection where possible (parietal pleurectomy or extrapleural pleuropneumonectomy), then chemotherapy (60 mg/m2 doxorubicin, 3 mg/m2 vindesine and 650 mg/m2 cyclophosphamide, repeated every 21 days), then radiotherapy (45.0 to 60.0 Gy) for patients in remission without progression. Group B received best supportive care. Asbestos exposure history was recorded by interview: 103 of 132 patients were positive and 29 negative or unknown. No fiber types are named.
• Main results:
  • Median survival was 13 months for combined-therapy patients (group A), 7 months for best supportive care (group B), and 5 months for ineligible patients (group NE).
  • Median progress-free survival was 6, 2 and 1 month for groups A, B and NE respectively.
  • Overall median survival for all 132 patients was 9 months.
  • Combined therapy (group A) was associated with survival when analysed on its own (P = 0.0005), but only marginally in the multivariate Cox analysis (P = 0.03).
  • Within group A, surgery showed no survival advantage over no surgery (42 operated, 15 not amenable to operation).
  • Among 21 patients with measurable disease at the start of chemotherapy, eight showed tumor regression and none had a complete remission. Partial response occurred in 4 (19%).
  • Six group A patients refused to continue chemotherapy after the first or second course because of subjective intolerance. In 7 patients chemotherapy was stopped for unacceptable toxicity before the fourth course.
  • Non-treatment factors associated with longer survival were good performance status (Karnofsky 90% to 100%, P = 0.005), stage I and II disease (P = 0.02), absence of chest pain (P = 0.01), age below 50 years (P = 0.01), and epithelial histology (P = 0.01).
  • Groups A and B differed in age, Karnofsky index, histology and operability.
• The authors' conclusion: The authors concluded that much of the treated patients' survival improvement could be attributed to other cofactors, but that multimodal treatment showed some prolongation of life expectancy. They described the finding that debulking surgery did not prolong median survival as the most significant finding of the study.
• Limitations the authors state:
  • Randomization was considered unfeasible because many patients, especially younger ones, preferred combined therapy, so groups were assigned by patient preference.
  • The authors note that the wish for treatment may itself be a positive selection factor.
  • The study design could not answer whether irradiation prolongs survival.

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, Pleura, Pleural Mesothelioma, Multimodal Therapy, Surgical Resection, Median Overall Survival, Life Expectancy, Performance Status.

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