Mesothelioma: new concepts in diagnosis and management

Our plain-English summary of Mesothelioma: new concepts in diagnosis and management, by A.M. Boylan (Current Opinion in Pulmonary Medicine, 2000).

The study

• Author: A.M. Boylan
• Journal: Current Opinion in Pulmonary Medicine
• Published: 2000;6(2):157-63
• Type of article: Review
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma is an uncommon, but no longer rare, cancer that is frequently difficult to diagnose and poorly responsive to therapy. Because of the difficulties distinguishing mesothelioma from metastatic adenocarcinoma and reactive pleural inflammation, thoracoscopy or open lung biopsy are usually required to obtain adequate samples for pathologic evaluation. Staging of mesothelioma remains a controversial area. Because none of the six staging systems used in the past was found to be predictive, a TNM-based staging system was recently proposed and is awaiting universal acceptance. Generally perceived as a death sentence, this cancer is associated with a median survival of 9 months from the time of diagnosis in most series, but newer therapeutic strategies show promise for improved and even long-term survival in select cases. Randomized trials are awaited to determine if the improvements in survival reported are not simply due to patient selection.

In plain English

This article was a narrative review of published research on diagnosing and treating malignant pleural mesothelioma. It reported no new data. Citing other studies, the author noted that series reported a history of asbestos exposure in 20–90% of cases (mean 70%). The review stated that the highest diagnostic yields (over 90%) came from thoracoscopy or open pleural biopsy, while cytology was usually not diagnostic. Most large series reported a median survival of 8–12 months from diagnosis, with fewer than 20% of patients alive at 2 years. One cited study treated 183 patients with extrapleural pneumonectomy followed by radiation and chemotherapy. In that study, the 31 patients with epithelial cell type, clean margins and negative lymph nodes had a 2-year survival of 68% and a 5-year survival of 46%. The author noted critics' point that this study was not randomized and that patient selection may account for the results. The author concluded that trimodality therapy gave the best reported results, but that survival gains were limited to patients with epithelial cell type and early-stage disease.

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 of published literature (no original data)
• Who was studied: No study population of its own; the article reviews published studies of malignant pleural mesothelioma (one section also mentions two cases of peritoneal mesothelioma)
• Exposure: Asbestos is discussed as background cause, with no fiber types specified. Citing other sources, the author listed groups at risk (asbestos industry workers, insulators, pipefitters, shipyard workers, brake mechanics, railroad workers, construction trades, household contacts, building maintenance workers). SV40 virus sequences are also mentioned, as an unresolved question.
• Main results:
  • Citing other studies: most large series reported a median survival of 8–12 months from diagnosis, with fewer than 20% of patients alive at 2 years
  • Citing other studies: the highest diagnostic yields (over 90%) were obtained with thoracoscopy or open pleural biopsy; cytology is usually not diagnostic
  • At least six staging systems had been proposed, but none had been uniformly used or shown to accurately predict survival; a TNM-based international system was recently proposed
  • In a cited study by Sugarbaker's group of 183 patients given extrapleural pneumonectomy followed by radiation and chemotherapy, the 31 patients with epithelial cell type, clean margins and negative lymph nodes had a 2-year survival of 68% and a 5-year survival of 46%; patients with sarcomatous or mixed cell type had a 2-year survival of 16%
  • Citing a review of chemotherapy trials: combination chemotherapy had not shown any survival benefit over single-agent chemotherapy
• The authors' conclusion: The author concluded that the best reported results came from trimodality therapy, but that improvements in survival were limited to patients with epithelial cell type and early-stage disease
• Limitations the authors state:
  • The author stated that analysis of chemotherapy trials is difficult because of small patient numbers and lack of uniform staging
  • The author noted that the trimodality study was not randomized and that patient selection may explain its favorable results

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Adenocarcinoma, Inflammation, Thoracoscopy, Biopsy, Staging, Median Survival.

Related studies

• Management options for malignant pleural mesothelioma: clinical and cost considerations — R.K. Goudar (2007)
• Current concepts in malignant pleural mesothelioma — A.J. Kaufman, H.I. Pass (2008)
• Management of malignant pleural mesothelioma - part 1: epidemiology, diagnosis, and staging : Consensus of the Austrian Mesothelioma Interest Group (AMIG) — C. Geltner, P. Errhalt, et al. (2016)
• Multimodality approach in management of malignant pleural mesothelioma — S. Neragi-Miandoab (2006)
• Advances in the diagnosis, evaluation, and management of malignant pleural mesothelioma — D.H. Sterman, S.M. Albelda (2005)
• British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma — I. Woolhouse, L. Bishop, et al. (2018)

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