Malignant pleural mesothelioma treatment: the current state of the art

Our plain-English summary of Malignant pleural mesothelioma treatment: the current state of the art, by G. Falkson, A.S. Alberts, H.C. Falkson (Cancer Treatment Reviews, 1988).

The study

• Authors: G. Falkson, A.S. Alberts, H.C. Falkson
• Journal: Cancer Treatment Reviews
• Published: 1988;15(4):231-42
• Type of article: Review
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This review, from the Department of Medical Oncology at the University of Pretoria, South Africa, examined the treatment of malignant pleural mesothelioma as reported in the published literature up to 1988. The authors outlined the disease's link to asbestos exposure, its natural history and its prognostic factors. They then reviewed results of surgery, radiotherapy, single-agent and combination chemotherapy, combined-modality treatment and intracavitary therapy. In one untreated series of 64 patients, median survival from symptom onset was 18 months. Performance status, duration of symptoms and stage were described as prognostic, while findings for histologic subtype, age and chest pain were inconsistent. Radical pleuropneumonectomy series reported 2-year survival of 10% to 37%, and operative mortality reached 31% in one series. Palliative pleurectomy controlled effusions, with median survivals of 16 to 21 months. Radiotherapy produced complete or partial responses in about 20% of patients without changing median survival. Palliation correlated with doses of at least 40 Gy in 4 weeks. Anthracyclines, high-dose cisplatin and carboplatin showed marginal activity, and combinations were disappointing. Intrapleural cisplatin produced responses in 2 of 12 patients. The authors concluded that no cytostatic drug justified standard use and that selecting good-prognosis patients for intensive treatment had led to erroneous conclusions. They called for prospectively stratified trials, particularly phase II trials of new agents.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This 1988 article, by authors at the University of Pretoria, South Africa, was a review of published results on treating malignant pleural mesothelioma. It reported no new patients of its own. It covered surgery, radiotherapy, chemotherapy, combinations of these, and treatments placed directly into the chest cavity. The authors wrote that prognosis was influenced more by known prognostic factors, such as a patient's general fitness and stage of disease, than by treatment. In their reading of the studies, radical surgery did not alter the course of the disease; one series of 29 patients had an operative death rate of 31%. Palliative removal of the pleura gave definite palliative benefit. Radiotherapy produced complete and partial responses in the region of 20% without affecting median survival. High-dose cisplatin and carboplatin showed marginal activity, and drug combinations were disappointing. The authors warned that young patients with good prognostic features tend to be selected for intensive treatment. They concluded that prospectively stratified clinical trials were the only way to find an acceptable treatment approach.

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: Review of published treatment results (surgery, radiotherapy, chemotherapy, combined and intracavitary treatment) for malignant pleural mesothelioma
• Who was studied: Published series of patients with malignant pleural mesothelioma treated in various centres; no new patients were studied by the authors
• Exposure: Asbestos exposure was not studied; the review concerns treatment. In the introduction the authors state that asbestos exposure plays a highly significant role in causing malignant pleural mesothelioma.
• Main results:
  • The authors stated that prognosis is influenced more by known prognostic factors than by treatment
  • In the reviewed series by Butchart (29 patients treated with pleuropneumonectomy), operative mortality was 31%
  • The authors judged that, on the reviewed results, radical surgery does not alter the natural history of the disease
  • The authors judged palliative pleurectomy to give definite palliative benefit (in the Martini et al. series of 14 patients, effusion was controlled in all)
  • Radiotherapy was judged to have limited activity, with complete and partial responses in the region of 20%
  • The few radiotherapy responses did not affect median survival of treated patients
  • In Gordon's series of 19 patients given palliative radiotherapy, 7 experienced 'some definite relief' or better and 12 minimal or no relief
  • High-dose cisplatin and carboplatin given as single agents showed marginal activity
  • Combinations of chemotherapy drugs gave disappointing results
  • Three combined-modality series reported survival over 20 months, but the reporting authors discussed that this may reflect selection of good-prognosis patients
  • Intrapleural cisplatin produced responses in only 2 of 12 patients (17%) in Kirmani's phase II trial
  • The authors noted that young patients with good prognostic features tend to be selected for more intensive treatment
• The authors' conclusion: The authors concluded that prospectively stratified clinical trials are the only way to find an acceptable treatment approach for this disease
• Limitations the authors state:
  • The authors noted that pooling small studies is risky because mainly positive results tend to be reported
  • The authors cautioned that results from small series without pathology panel confirmation of the diagnosis must be interpreted with caution
  • The authors stated that differences in prognostic factors among patients selected for radiotherapy make comparisons between series impossible

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, State-of-the-Art Defense, Asbestos Exposure, Chemotherapy, Median Overall Survival, Performance Status, Histological Subtype, Palliative Care.

Related studies

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• Malignant pleural mesothelioma: a disease unaffected by current therapeutic maneuvers — A.S. Alberts, G. Falkson, et al. (1988)
• Malignant pleural mesothelioma: current concepts in treatment — A. Tsiouris, R.K. Walesby (2007)
• Clinical features and current treatment of diffuse malignant pleural mesothelioma — V.W. Rusch (1995)
• Current surgical treatment of malignant pleural mesothelioma — K. Chihara (2018)
• Malignant Pleural Mesothelioma: State-of-the-Art on Current Therapies and Promises for the Future — F. Nicolini, M. Bocchini, et al. (2019)

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