Malignant pleural mesothelioma

Our plain-English summary of Malignant pleural mesothelioma, by C. Boutin, M. Schlesser, C. Frenay, et al (The European Respiratory Journal, 1998).

The study

• Authors: C. Boutin, M. Schlesser, C. Frenay, P. Astoul
• Journal: The European Respiratory Journal
• Published: 1998;12(4):972-81
• Type of article: Review
• Cited by: 130 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The incidence of malignant pleural mesothelioma (MPM) has risen for some decades and is expected to peak between 2010 and 2020. Up to now, no single treatment has been proven to be effective and death usually occurs within about 12-17 months after diagnosis. Perhaps because of this poor prognosis, early screening has incited little interest. However, certain forms may have a better prognosis when diagnosed early and treated by multimodal therapy or intrapleural immunotherapy. Diagnosis depends foremost on histological analysis of samples obtained by thoracoscopy. This procedure allows the best staging of the pleural cavity with an attempt to detect visceral pleural involvement, which is one of the most important prognostic factors. Although radiotherapy seems necessary and is efficient in preventing the malignant seeding after diagnostic procedures in patients, there has been no randomized phase III study showing the superiority of any treatment compared with another. However, for the early-stage disease (stage I) a logical therapeutic approach seems to be neoadjuvant intrapleural treatment using cytokines. For more advanced disease (stages II and III) resectability should be discussed with the thoracic surgeons and a multimodal treatment combining surgery, radiotherapy and chemotherapy should be proposed for a randomized controlled study. Palliative treatment is indicated for stage IV. In any case, each patient should be enrolled in a clinical trial.

In plain English

This article was a review describing what was known in 1998 about malignant pleural mesothelioma. It covered incidence, how asbestos fibres reach the pleura, symptoms, diagnosis, staging, prognosis and treatment. Most figures came from earlier studies, several by the authors' own group in Marseille, France. Cited data put yearly incidence in industrialized countries at 2 per million in women and 10–30 per million in men, and median survival at 12 to 17 months. In the authors' earlier series, thoracoscopy (examining the chest cavity through a small scope) gave a diagnosis in 185 of 188 cases. In an earlier randomized trial of 40 patients, tumour spread along the instrument path occurred in none of 20 patients given preventive radiotherapy and in 8 of 20 who were not. The authors stated that, for stage II and III disease, no randomized study had shown any treatment to be better than another. They concluded that early-stage disease appeared to be the most important factor for treatment success, and they recommended preventive radiotherapy after diagnostic procedures.

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: Narrative review, the last article in a journal series on the pleura. It is not an original study, and much of the data comes from earlier studies, including the authors' own.
• Who was studied: No new study population. The review covers published research on malignant pleural mesothelioma and draws repeatedly on the authors' earlier series of 188 patients at the Department of Pulmonary Diseases, Hôpital de La Conception, Marseille, France.
• Exposure: Asbestos exposure in general, occupational and non-occupational. The authors state, citing other studies, that incidence is higher with crocidolite and amosite than with chrysotile.
• Main results:
  • Cited data: in industrialized countries that used asbestos widely from the end of World War II to the end of the 1970s, yearly mesothelioma incidence was 2 per million in females and 10–30 per million in males.
  • Cited study (1989–1993) in south-east France: annual incidence was 14.2 per million in males and 1 per million in females in Provence, and 16.2 per million in males and 1 per million in females in Corsica.
  • Cited earlier study of thoracoscopic biopsies from 14 subjects (eight asbestos-exposed, six unexposed). In exposed subjects, mean fibre concentrations were 12.4 ± 9.8 million fibres per gram of dry tissue in lung, 4.1 ± 1.9 in pleural 'black spots' and 0.5 ± 0.2 in normal pleura. In unexposed subjects the figures were 0, 0.3 ± 0.1 and 0. Amphiboles outnumbered chrysotile in all samples.
  • Authors' earlier series: diagnosis was achieved by cytology alone in 26% of cases, by closed pleural biopsy in 20.7%, and by the two combined in 38.7%. Medical thoracoscopy allowed diagnosis in 185 of 188 cases (98.4%).
  • Cited median survival ranged from 12 to 17 months depending on the series, and 5-year survival was less than 5%.
  • Cited randomized trial in 40 mesothelioma patients: seeding of the chest wall was seen in none of the 20 patients given prophylactic radiation therapy and in eight of the 20 who were not.
  • Intrapleural immunotherapy with interferon-gamma: overall complete or partial response was 19.1%, with responses in 44.8% of stage I patients and 6% of stage II patients. Of 22 patients treated with interleukin-2, there was one complete response and 11 partial responses. Median survival was 28 months in responders and 8 months in nonresponders (p less than 0.01).
  • For stage II and III disease, the authors stated that no randomized study had shown any treatment to be superior to another.
• The authors' conclusion: The authors concluded that early-stage disease appeared to be the most important factor for treatment success. They recommended prophylactic local radiotherapy after diagnostic procedures. They suggested neoadjuvant intrapleural treatment for stage I, multimodal treatment or medical treatment for stages II and III, and only palliative treatment for stage IV.
• Limitations the authors state:
  • The authors describe the incidence data as unreliable.
  • The exact incidence in France is not known because there is no national register.
  • The authors state that pilot studies of intrapleural treatment were still under way and that its results need confirmation in comparative studies with surgery.

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, Prognosis, Multimodal Therapy, Immunotherapy, Thoracoscopy, Staging, Pleural Cavity, Cytokine.

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