Management of malignant pleural mesothelioma: a critical review

Our plain-English summary of Management of malignant pleural mesothelioma: a critical review, by Y.C. Lee, R.W. Light, A.W. Musk (Current Opinion in Pulmonary Medicine, 2000).

The study

• Authors: Y.C. Lee, R.W. Light, A.W. Musk
• Journal: Current Opinion in Pulmonary Medicine
• Published: 2000;6(4):267-74
• Type of article: Review
• Cited by: 45 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma remains a uniformly fatal disease and best supportive care continues to be the standard treatment. Neither chemotherapy nor surgery has been shown to prolong survival. Radiotherapy is not curative but is useful for prophylaxis against needle-track metastases and for symptom palliation. Combinations of therapies have been tried but most studies were uncontrolled and selection bias makes the results impossible to interpret. The combination of extrapleural pneumonectomy, chemotherapy, and radiotherapy attracted much interest, but the subsequent results were disappointing in a highly selected group of patients. Randomized controlled trials are desperately needed to provide definitive information on experimental treatments. It is also important to develop better measures of disease response and to assess quality of life issues in clinical trials. If patients are to receive therapies other than palliation, they should only do so in the setting of randomized controlled trials under approved protocols.

In plain English

This article was a review, not a new study of patients. The authors summarized published research on treating malignant pleural mesothelioma (cancer of the lining around the lungs). They noted a striking lack of randomized controlled trials and frequent selection bias. In their reading, neither main operation (pleurectomy or extrapleural pneumonectomy) had been shown to improve survival. No chemotherapy drug had been found effective, and radiotherapy alone had no effect on survival. Immunotherapy could shrink tumors but had not been shown to prolong survival. They cited one randomized trial in which 8 of 20 control patients developed tumor seeding after invasive procedures, compared with none of 20 patients given preventive radiotherapy. They also discussed a cited series of 183 highly selected patients given surgery, chemotherapy and radiotherapy. They called its 19-month median survival disappointing and estimated that at most 1 to 2% of all patients could potentially benefit. The authors concluded that no treatment had been shown to cure or prolong survival and that best supportive care remained the standard.

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 (critical) review of published literature on the treatment of malignant mesothelioma
• Who was studied: No patients were studied directly; the review covered published studies of treatments for malignant (mainly pleural) mesothelioma
• Main results:
  • The authors found a striking lack of randomized controlled trials of mesothelioma treatments, and found selection bias to be extremely common in the published studies
  • Pleurectomy and extrapleural pneumonectomy: according to the review, neither operation is curative and neither has been shown to improve survival
  • Systemic chemotherapy: according to the review, no chemotherapy drug had been found effective for mesothelioma
  • Radiotherapy given alone: the review reported no effect on patient survival
  • Preventive radiotherapy (from a cited randomized trial, not this article): 8 of 20 patients in the control group developed malignant seedlings after invasive procedures, compared with none of the 20 patients in the treatment group
  • Immunotherapy: the review reported that it could reduce tumor size but had not been shown to prolong survival or provide a cure
  • Combined surgery, chemotherapy and radiotherapy: the authors described the median survival of 19 months in a cited, highly selected series as disappointing; that series included 183 patients
  • The authors estimated that at most 1 to 2% of all mesothelioma patients could potentially benefit from this combined surgery, chemotherapy and radiotherapy regimen
• The authors' conclusion: The authors concluded that no treatment had been shown to cure mesothelioma or prolong patients' survival, and that best supportive care remained the standard management

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, Mesothelioma, Chemotherapy, Selection Bias, Extrapleural Pneumonectomy (EPP), Quality of Life, Clinical Trial.

Related studies

• Multicenter randomized controlled trial of the management of unresectable malignant mesothelioma proposed by the British Thoracic Society and the British Medical Research Council — D.J. Girling, M.F. Muers, et al. (2002)
• Management options for malignant pleural mesothelioma: clinical and cost considerations — R.K. Goudar (2007)
• Efficacy of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in the management of malignant ascites — R.W. Randle, K.R. Swett, et al. (2014)
• Current issues in malignant pleural mesothelioma evaluation and management — J. Ai, J.P. Stevenson (2014)
• Future developments in the management of malignant pleural mesothelioma — P.A. Zucali, F. De Vincenzo, et al. (2009)
• Multimodality approach in management of malignant pleural mesothelioma — S. Neragi-Miandoab (2006)

Browse more research in Current Opinion in Pulmonary Medicine, or return to medical research.