Management of malignant pleural mesothelioma

Our plain-English summary of Management of malignant pleural mesothelioma, by P. Hürmüz (Thoracic Cancer, 2010).

The study

• Author: P. Hürmüz
• Journal: Thoracic Cancer
• Published: 2010;1(2):53-61
• Type of article: Review
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma is a rare neoplasm arising from the surface serosal cells of the pleural cavity. More than 80% of cases of malignant pleural mesothelioma have been attributed to asbestos exposure. In its natural course median survival is 4 to 12 months. If untreated most of patients die due to local complications of the disease. Surgery improves local control but is not sufficient as a single treatment modality. The recommended treatment strategy for a select group of patients is multimodal therapy that includes surgery, radiotherapy and chemotherapy.

© Tianjin Lung Cancer Institute and Blackwell Publishing Asia Pty. Ltd.

In plain English

This article was an invited review, not an original study, by an author from a radiation oncology department in Trabzon, Turkey. It summarized published research on malignant pleural mesothelioma, a cancer of the lining of the chest cavity. The author wrote that epidemiological studies have established asbestos exposure as the main cause. The review stated that amphibole fibers, especially crocidolite, are most clearly associated with the disease, and that chrysotile has been shown to be less carcinogenic. The review also discussed erionite, a non-asbestos fiber found in some Turkish villages, the SV40 virus, and inherited susceptibility, before covering diagnosis and treatment. According to the review, median survival is 4 to 12 months, and surgery alone is not sufficient. One trial it described randomized 456 patients and reported median survival of 12.1 months with pemetrexed plus cisplatin versus 9.3 months with cisplatin alone. Studies of radiotherapy to prevent tumor growth at procedure sites gave conflicting results, and the author noted these studies were small. The author concluded that no treatment works on its own and that patients with good performance status should receive combined 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: invited narrative review of published literature
• Who was studied: No study population of its own; the author reviewed published studies of patients with malignant pleural mesothelioma
• Exposure: The review identifies asbestos as the main cause of malignant pleural mesothelioma. Amphibole fibers, especially crocidolite, are most clearly associated with it, and chrysotile (a serpentine fiber) is described as less carcinogenic. The review also discusses erionite, SV40 virus and genetic predisposition.
• Main results:
  • The review states that median survival for malignant pleural mesothelioma patients is 4 to 12 months.
  • The review states that surgery improves local control but is not sufficient as a single treatment.
  • In a cited randomized phase III trial of 456 chemo-naive patients, median survival was 12.1 months with pemetrexed-cisplatin versus 9.3 months with cisplatin alone (p = 0.020).
  • In a cited study by Sugarbaker et al. of 183 patients treated with extrapleural pneumonectomy, chemotherapy and hemithoracic radiotherapy, two-year survival was 38% and five-year survival was 15%.
  • In a cited randomized study by Boutin et al. of 40 patients, no patient given radiotherapy at the procedure site developed skin nodules, compared with 8 of 20 untreated patients. Two other cited studies found no difference between groups.
• The authors' conclusion: The author concluded that none of the treatment types is effective on its own and that patients with good performance status should undergo multimodal treatment. The author also concluded that long-term survival is still not possible and that more effective systemic treatments should be sought.
• Limitations the authors state:
  • About the reviewed studies of radiotherapy to prevent tumor spread at procedure sites, the author noted that patient numbers were small, radiotherapy doses and techniques differed, and tumor histology was mostly not reported.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Neoplasm, Pleural Cavity, Asbestos Exposure, Median Survival, Multimodal Therapy, Chemotherapy.

Related studies

• Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma — A. Scherpereel, P. Astoul, et al. (2010)
• Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients — E.G. Butchart, T. Ashcroft, et al. (1976)
• Diagnosis and initial management of nonmalignant diseases related to asbestos — American Thoracic Society (2004)
• British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma — I. Woolhouse, L. Bishop, et al. (2018)
• British Thoracic Society study of cryptogenic fibrosing alveolitis: current presentation and initial management. Fibrosing Alveolitis Subcommittee of the Research Committee of the British Thoracic Society — I.D. Johnston, R.J. Prescott, et al. (1997)
• Pleurectomy/decortication is superior to extrapleural pneumonectomy in the multimodality management of patients with malignant pleural mesothelioma — L. Lang-Lazdunski, A. Bille, et al. (2012)

Browse more research in Thoracic Cancer, or return to medical research.