Malignant mesothelioma of the pleura: review of 123 patients

Our plain-English summary of Malignant mesothelioma of the pleura: review of 123 patients, by J. Brenner, P.P. Sordillo, G.B. Magill, et al (Cancer, 1982).

The study

• Authors: J. Brenner, P.P. Sordillo, G.B. Magill, R.B. Golbey
• Journal: Cancer
• Published: 1982;49(11):2431-5
• Cited by: 203 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. 000662).

Abstract

One-hundred-twenty-three cases of malignant pleural mesothelioma were reviewed. Exposure to asbestos or to other industrial dusts or chemicals was an important etiologic factor with 24% of patients relating such a history. A history of prior irradiation or previous lung disease was also occasionally noted. Diagnosis was most often made by exploratory thoracotomy, with pleural biopsy or cytology rarely helpful. Except for nine patients, tumor was confined to the chest at the time of diagnosis, but in 33 of the remaining 114 patients, spread to the abdomen or distant metastasis was seen during the course of disease. Surgery and radiotherapy were ineffective in preventing local recurrence. There were only three major responses to chemotherapy in 111 trials. Median survival was 12 months, and only seven patients (5.6%) lived more than five years. Patients with epithelial mesothelioma and Stage I disease had the most favorable prognosis.

In plain English

This study reviewed the hospital records of 123 patients with malignant pleural mesothelioma (cancer of the lining of the chest) seen at Memorial Sloan-Kettering Cancer Center in New York between 1949 and 1980. There were 84 men and 39 women, with a median age of 56. Sixteen patients (13%), all men, had a history of asbestos exposure. Fourteen others had worked in industries with other dusts or chemicals. The article did not say what types of asbestos were involved. Diagnosis was most often made during chest surgery (91 patients). Testing fluid from the chest gave a definite diagnosis in only seven of the 60 patients who had such fluid. There were only three major responses in 111 chemotherapy trials. Median survival was 12 months, and seven patients (5.6%) survived more than five years. Median survival was 16 months for epithelial and 12 months for fibrosarcomatous mesothelioma, and it was shorter at later stages. The authors concluded that the outlook remained poor. They noted that treatment was hard to judge after the fact because many different treatments had been used.

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: Retrospective review of hospital records (case series from a single institution)
• Who was studied: 123 patients with malignant pleural mesothelioma seen at Memorial Sloan-Kettering Cancer Center, New York, 1949-1980; 84 male and 39 female; median age 56 years (range 5-77)
• Exposure: Patient-reported history of asbestos exposure in 16 patients (13%), all male; fiber type, products and doses not reported. Another 14 patients worked in industries with exposure to other dusts or chemicals (stone cutters, leather factory or textile factory workers). One patient had prior chest radiation for Hodgkin's disease.
• Main results:
  • 16 of 123 patients (13%) had a history of asbestos exposure; all 16 were male
  • 45 of the 123 patients (36%) were smokers
  • Diagnosis was most often made at thoracotomy (91 patients). Of the 60 patients with pleural effusion at diagnosis, pleural fluid showed malignant cells in 22 and gave a definite diagnosis of mesothelioma in 7.
  • Disease was confined to the chest at diagnosis in 114 patients (93%). Over the course of disease, the tumor spread to the abdomen or distant organs in 42 patients (34%).
  • 78 patients received chemotherapy (111 patient trials), with only three major responses
  • Among all patients, median survival was 12 months; 7 patients (5.6%) survived more than five years; the longest survival was 12 years
  • Median survival was 16 months for patients with epithelial mesothelioma and 12 months for those with fibrosarcomatous mesothelioma
  • Survival was influenced by stage. Median survival was 13 months for Stage I (62 patients), 11.5 months for Stage II (52), 4.5 months for Stage III (7) and 4 months for Stage IV (2), per Table 7.
  • Median survival was 13 months in patients given adjuvant radiotherapy after surgery, compared with 15 months for surgery alone
• The authors' conclusion: The authors concluded that the outlook for patients with mesothelioma remained poor. Occasional responses were achieved with chemotherapy or radiotherapy, but most patients died within two years of diagnosis. They said multi-institutional trials would be needed to find more effective chemotherapy.
• Limitations the authors state:
  • The authors stated that treatment is very difficult to evaluate retrospectively because various types of surgery, radiation and chemotherapy were used
  • The authors noted that the radiotherapy and surgery-alone groups were not comparable: most patients given radiotherapy had incompletely resected disease, while many treated with surgery alone had complete resection

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, Thoracotomy, Pleural Biopsy, Cytology, Metastasis, Chemotherapy.

Related studies

• Malignant mesothelioma of the pleura in Barrow-in-Furness — J.R. Edge, S.L. Choudhury (1978)
• Mesotheliomas and secondary tumors of the pleura — K. Ellis, M. Wolff (1977)
• Phase-II study with the combination of cisplatin and doxorubicin in advanced malignant mesothelioma of the pleura — H. Henss, H.H. Fiebig, et al. (1988)
• Mortality from mesothelioma of the pleura during 1968-78 in England and Wales — M.J. Gardner, E.D. Acheson, et al. (1982)
• Deciduoid mesothelioma of the pleura in an adolescent boy — L.Y. Tsai, Y.L. Yang, et al. (2010)
• Malignant mesothelioma in children: report of seven cases and review of the literature — J. Brenner, P.P. Sordillo, et al. (1981)

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