Malignant pleural mesothelioma

Our plain-English summary of Malignant pleural mesothelioma, by S. Raja, S.C. Murthy, D.P. Mason (Current Oncology Reports, 2011).

The study

• Authors: S. Raja, S.C. Murthy, D.P. Mason
• Journal: Current Oncology Reports
• Published: 2011;13(4):259-64
• Type of article: Review
• Cited by: 25 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is a relatively rare thoracic malignancy accounting for about 2000-3000 new cases per year. This cancer has been increasing in incidence and is strongly associated with asbestos exposure. Also, it is characterized by insidious growth and clinical presentation at an advanced stage of disease. In the past, the treatment of this disease was limited to marginally effective chemotherapy and morbid surgery. This review explores the clinical presentation of MPM, its diagnostic approach and the relevant and recent studies that define the role of chemotherapy, radiation, and various surgical options. Currently, even with aggressive surgical interventions and multimodality strategies, cure remains elusive, although life prolongation has been achieved. Additionally, promising new therapies and interventions that are currently being studied are introduced in this review.

In plain English

This article was a review of malignant pleural mesothelioma, a cancer of the lining around the lungs. It did not study new patients. The authors described the disease as directly linked to asbestos exposure and said it usually appears two to three decades after exposure. They also noted that a significant minority of patients report no history of asbestos exposure. They then summarized other studies on diagnosis, staging and treatment. In one cited trial, pemetrexed plus cisplatin gave a 23% overall risk reduction compared with cisplatin alone, and median survival rose from 9.3 to 12.1 months. In a cited study of 312 surgical patients, median survival was 15.3 months for the epithelioid subtype and 5 months for the sarcomatoid subtype. The authors stated that the data did not clearly favor either main operation, extrapleural pneumonectomy or pleurectomy (P/D). The authors concluded that chemotherapy has shown efficacy. Even with aggressive surgery and combined treatments, they wrote, cure remains elusive, although life prolongation is likely.

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 of the literature (no original data)
• Who was studied: Published studies on malignant pleural mesothelioma covering diagnosis, chemotherapy, radiation and surgery; no new patient group was studied
• Exposure: Asbestos exposure as background. The authors attributed the rising incidence to the widespread use of asbestos as an insulator in the latter half of the last century.
• Main results:
  • The authors stated that mesothelioma typically develops two to three decades after asbestos exposure.
  • The authors noted that a significant minority of patients with this cancer report no history of asbestos exposure.
  • The authors stated that the needle-like shape of amphibole asbestos fibers is believed to be responsible for chronic irritation that leads to the cancer in a small subset of patients.
  • In a cited phase 3 trial, pemetrexed plus cisplatin gave an overall 23% risk reduction compared with cisplatin alone, and median survival increased from 9.3 to 12.1 months.
  • A cited study of 312 patients having surgery for this cancer looked at how tumor type affected survival.
  • In that cited study, patients with the epithelioid subtype had a median survival of 15.3 months.
  • In that cited study, patients with the sarcomatoid subtype had a median survival of 5 months.
  • The authors stated that the data do not clearly favor extrapleural pneumonectomy or pleurectomy (P/D) for any stage of the disease.
  • In the largest cited series of chemotherapy given into the chest cavity during surgery (92 patients at Brigham and Women's Hospital), local recurrence in the same side of the chest was 34%.
• The authors' conclusion: The authors concluded that even with aggressive surgery and combined treatment strategies, cure is elusive, although life prolongation is likely.
• Limitations the authors state:
  • The authors noted that photodynamic therapy had not been validated by any large studies.
  • The authors noted that a pending trial of chemotherapy before extrapleural pneumonectomy had small enrollment, which may limit interpretation of its results.

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, Asbestos Exposure, Chemotherapy.

Related studies

• Important prognostic factors in patients with malignant pleural mesothelioma, managed surgically — V.W. Rusch, E.S. Venkatraman (1999)
• Radical pleurectomy and intraoperative photodynamic therapy for malignant pleural mesothelioma — J.S. Friedberg, M.J. Culligan, et al. (2012)
• Current approach to malignant mesothelioma of the pleura — J. Aisner (1995)
• Intrapleural recombinant IL-2 in passive immunotherapy for malignant pleural effusion — P. Astoul, J.R. Viallat, et al. (1993)
• Systematic review of pleurectomy in the treatment of malignant pleural mesothelioma — C. Cao, D.H. Tian, et al. (2013)
• Clinical Outcomes With Recurrence After Pleurectomy/Decortication for Malignant Pleural Mesothelioma — A. Nakamura, T. Takuwa, et al. (2020)

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