Malignant pleural mesothelioma: a disease unaffected by current therapeutic maneuvers

Our plain-English summary of Malignant pleural mesothelioma: a disease unaffected by current therapeutic maneuvers, by A.S. Alberts, G. Falkson, L. Goedhals, et al (Journal of Clinical Oncology, 1988).

The study

• Authors: A.S. Alberts, G. Falkson, L. Goedhals, D.A. Vorobiof, C.A. Van der Merwe
• Journal: Journal of Clinical Oncology
• Published: 1988;6(3):527-35
• Cited by: 191 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. 000184).

Abstract

From 1965 to 1985, 262 patients with malignant pleural mesothelioma were treated with cytostatics only; radiotherapy (RT); RT and cytostatics; or decortication plus RT plus cytostatics. The median survival (MS) from diagnosis was 9.6 months. This was similar for all comparable treatment groups. In a univariate analysis, significant favorable prognostic factors were good performance status (PS), duration of symptoms greater than 6 months at the time of diagnosis, early stage of disease, white race, and female sex. In a multivariate analysis, PS, race, duration of symptoms, and stage were of significance for a favorable prognosis. Age, pain as first symptom, histologic subtype, and RT dose were not of prognosis significance in this study. The stepwise addition of treatment modalities did not increase survival, which remained the same as that reported for untreated patients. Therefore, phase II trials of new agents offer the only hope for advance in the treatment of this disease.

In plain English

This retrospective study reviewed 262 patients with malignant pleural mesothelioma seen from 1965 to 1985 at two academic hospitals near South Africa's major asbestos fields. A history of asbestos exposure was recorded in 58.4% of them. The article does not report fiber types for these patients. Treatment included chemotherapy, radiotherapy, combinations of the two, or surgery (decortication) plus both. It followed the hospital protocol in use at the time, not random assignment. Median survival from diagnosis for all patients was 287 days (9.6 months). It was similar across treatment groups, except a small group of 10 given radiotherapy plus doxorubicin (679 days). In a multivariate analysis, performance status (how active patients were), race, duration of symptoms and stage were linked to survival. Treatment no longer contributed once the radiotherapy-plus-doxorubicin group was removed. Histologic subtype, radiotherapy dose and age were not prognostically significant. The authors concluded that adding treatments step by step did not increase survival, and that phase II trials of new drugs were of prime importance. They noted that response was hard to measure and that the treatment groups were not balanced.

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 analysis of patient records (treatment and survival study)
• Who was studied: 277 patients with histologically confirmed malignant pleural mesothelioma seen from 1965 to 1985 at two academic hospitals near the major asbestos fields of South Africa. 15 were excluded for inadequate records, leaving 262 analyzed (median age 55; 81% white, 19% black; 72% male).
• Exposure: A history of asbestos exposure was obtained in 58.4% of patients. Fiber types were not reported for these patients, and the time of exposure was not determined. The main comparison was between treatments: chemotherapy alone (77 patients), radiotherapy alone (13), radiotherapy plus doxorubicin (10), cyclophosphamide (33) or procarbazine (14), radiotherapy plus combined chemotherapy (61), decortication plus radiotherapy plus combined chemotherapy (26), and minor groups (28).
• Main results:
  • Median survival for all 262 patients, measured from diagnosis, was 287 days (9.6 months).
  • 76 patients responded to treatment: 16 complete and 60 partial responses.
  • The best response was 12 of 26 patients in the decortication plus radiotherapy plus combined chemotherapy group. The poorest was 0 of 19 in the acivicin group.
  • Median survival was similar across treatment groups, except the small radiotherapy-plus-doxorubicin group (10 patients). That group's median survival was 679 days, about twice that of the other groups.
  • In univariate analysis, median survival ran from 399 days for performance status 0 to 33 days for performance status 4. It was 367 days with symptoms for more than 6 months versus 260 days with symptoms for less than 6 months. By stage it ran from 324 days (stage I) to 65 days (stage IV). It was 306 days for white versus 175 days for black patients, and 382 days for female versus 263 days for male patients.
  • In the Cox multivariate model, five factors contributed significantly to longer survival: performance status (P less than .0001), treatment (P = .0004), race (P = .0006), duration of symptoms (P = .0079) and stage (P = .0285).
  • When the radiotherapy-plus-doxorubicin group was removed from the model, treatment no longer contributed to better survival.
  • Female sex did not contribute significantly in the multivariate model. The authors explained that female patients had better performance status and earlier disease.
  • Several factors were not prognostically significant: histologic subtype (P = .628), radiotherapy dose (P = .1849) and age (P = .2012).
  • Adding treatment modalities step by step did not increase survival.
• The authors' conclusion: The authors concluded that the study gave no justification for treating patients with the "best available treatment". They concluded that phase II trials of new drugs were of prime importance.
• Limitations the authors state:
  • Treatments were given in sequence according to the protocol of the time. Patients were not allocated to treatment groups at random.
  • Treatment groups differed in prognostic factors such as performance status, sex, stage and race.
  • Response to treatment was difficult to measure.
  • Histology was not subclassified before the mid-1970s, and subclassification was unreliable.
  • The small number of black patients made statistical analysis more difficult. It was not clear why black patients had poorer survival.
  • The timing of asbestos exposure was not determined.

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, Median Survival, Performance Status, Multivariate Analysis, Prognosis, Histological Subtype.

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