Malignant pleural mesothelioma: overview of the North American and European experience

Our plain-English summary of Malignant pleural mesothelioma: overview of the North American and European experience, by J. Kukreja, M.T. Jaklitsch, D.C. Wiener, et al (Thoracic Surgery Clinics, 2004).

The study

• Authors: J. Kukreja, M.T. Jaklitsch, D.C. Wiener, D.J. Sugarbaker, S. Burgers, P. Baas
• Journal: Thoracic Surgery Clinics
• Published: 2004;14(4):435-45
• Type of article: Review
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

MPM is an uncommon disease with limited treatment options. Early diagnosis, a standardized staging system, early referral to centers experienced in MPM, and efforts to develop collaborative multicenter trials are essential to improving treatment for patients with MPM. Efforts to manage this malignancy, which is projected to peak in the twenty-first century, constitute an important international health concern, particularly because the use of asbestos, despite successful regulatory efforts in many parts of the world, continues unabated in others.

In plain English

This article was a narrative review, not a new study. Its authors, from Boston and Amsterdam, described malignant pleural mesothelioma (MPM) in North America and in Europe. They drew on published research, including work from their own centers, and covered asbestos history and regulation, how often the disease occurs, diagnosis, staging, and treatment. Figures the review cited from other work included 2000 to 3000 new US cases a year (an annual rate of 14 per million men and 3 per million women) and a European 5-year survival rate of 6.7% (confidence interval 3.8% to 11.7%) from the Eurocare-2 study. It also cited use of 614,000 tons of chrysotile and 70,000 tons of crocidolite in Slovenia between 1946 and 1996. It noted tremolite exposure in parts of Corsica, Sicily and Greece. The review reported that the death rate from extrapleural pneumonectomy surgery at Brigham and Women's Hospital fell from 6% after the first 31 patients to 3.4% after 328 patients. The authors concluded that early diagnosis, a standardized staging system, early referral to experienced centers, and collaborative multicenter trials are essential to improving treatment.

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 in two sections, North American and European, written by different author groups; no new data or study methods are described
• Who was studied: Patients with malignant pleural mesothelioma in North America and Europe, as described in published literature, with a focus on the experience of one Boston center (Brigham and Women's Hospital and Dana Farber Cancer Institute)
• Exposure: Asbestos exposure in general. The review discusses occupational exposure (for example New England shipyards and asbestos-associated industries) and environmental exposure to tremolite in northeast Corsica, eastern Sicily and northwest Greece. It also discusses erionite, a non-asbestos mineral fiber, in Cappadocia, Turkey. It cites use of chrysotile and crocidolite in Slovenia.
• Main results:
  • The review cited other sources for US incidence: 2000 to 3000 new cases a year, an annual rate of 14 cases per million men and 3 cases per million women
  • Operative mortality after extrapleural pneumonectomy at Brigham and Women's Hospital, as reported in earlier papers: 6% after the first 31 patients, 5.8% after 52, 5% after 120, 3.8% after 183, and 3.4% after 328 patients
  • A 1980 report by Antman cited in the review: of 40 MPM patients treated between 1965 and 1978 in Boston, 63% reported known asbestos exposure or had worked in New England shipyards
  • European 5-year survival for mesothelioma patients was 6.7% (confidence interval 3.8% to 11.7%), according to Eurocare-2 data pooled from 17 European centers for 1985 to 1989
  • Cited asbestos use in Slovenia: 614,000 tons of chrysotile and 70,000 tons of crocidolite between 1946 and 1996, peaking in 1982
  • Pleural fluid cytology was cited as having a diagnostic sensitivity of only 32%; biopsy by videothoracoscopy was cited as having a diagnostic rate of 98%
  • In a cited phase III trial, one-year survival was 45.5% in 125 patients given raltitrexed plus cisplatin and 39.4% in 124 patients given cisplatin alone (p = 0.056)
  • A cited randomized phase III trial showed a survival benefit of approximately 3 months for patients given cisplatin and pemetrexed compared with cisplatin alone
• The authors' conclusion: The authors concluded that early diagnosis, a standardized staging system, early referral to centers experienced in MPM, and collaborative multicenter trials are essential to improving treatment. They also concluded that the disease is an international health concern because asbestos use continues in some parts of the world.
• Limitations the authors state:
  • The authors noted that the exact US incidence is hard to determine because there is no national mesothelioma registry, and that the SEER database covers only 12% of the US population
  • The authors noted that the Brigham/Dana Farber staging system rests on one institution's experience and needs validation at multiple institutions

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, Staging.

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