Mesothelioma: time to take stock

Our plain-English summary of Mesothelioma: time to take stock, by C. Tan, T. Treasure (Journal of the Royal Society of Medicine, 2005).

The study

• Authors: C. Tan, T. Treasure
• Journal: Journal of the Royal Society of Medicine
• Published: 2005;98(10):455-8
• Type of article: Review
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Summary of the article

In this review, two cardiothoracic surgeons from Guy's and St Thomas's, London, challenged the common view that little can be done for mesothelioma and described management strategies and the evidence for them. They reported that registered UK mesothelioma deaths rose from 153 in 1968 to 1862 in 2002, with a predicted peak of 1950 to 2450 deaths per year between 2011 and 2015. Most or nearly all UK deaths were attributed to asbestos exposure, and the rise followed the rise in asbestos imports. They outlined asbestos types and uses, UK regulation including the 1992 import ban, and continuing asbestos use in some developing countries. On chemotherapy, they cited a 23% response rate for cisplatin alone. They also cited a phase III trial in 456 patients in which cisplatin plus pemetrexed gave a 41.3% response rate and a longer median time to progression than cisplatin alone (5.7 versus 3.9 months). Radiotherapy was reported to prevent tumour growth at drain and biopsy sites and to relieve chest wall pain. The authors argued that the benefits of radical surgery had not been proven in randomized trials and that comparisons with historical controls were invalid. They concluded that trimodality therapy should be evaluated only within randomized trials. They did not favour screening, and recommended prompt diagnosis, palliation, treatment within trials, symptom control and referral for legal and compensation advice.

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 article was a narrative review, not a new study, by two authors covering mesothelioma and its treatment. Citing UK figures, the authors reported 153 registered mesothelioma deaths in 1968 and 1862 in 2002, with a predicted peak of 1950 to 2450 deaths per year between 2011 and 2015. They stated that most or nearly all UK mesothelioma deaths were due to asbestos exposure. Summarizing other studies, they described a trial in 456 patients where cisplatin plus pemetrexed gave a longer median time to progression than cisplatin alone (5.7 versus 3.9 months). They also described a randomized trial in 40 patients where radiotherapy to drain, aspiration or biopsy sites prevented tumour nodules at those sites. They noted that radical surgery alone had not shown a demonstrable increase in survival. The authors' own earlier study of two patient series given best supportive care found widely different survival. They concluded that combined chemotherapy, surgery and radiotherapy can only be evaluated in randomized trials, and that screening did not currently appear to be in patients' best interests.

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 and commentary on mesothelioma epidemiology, asbestos, pathology and treatment (surgery, chemotherapy, radiotherapy, screening), drawing on published studies
• Who was studied: No new patients were studied. The article reviewed published evidence, mainly on mesothelioma in the UK, and referred to the authors' earlier survival study of two series of patients
• Exposure: Asbestos in general. The article describes chrysotile (white asbestos) and the amphiboles crocidolite (blue asbestos), amosite (brown asbestos), tremolite, actinolite and anthrophyllite. Exposure settings named include shipbuilding, the railway industries, building trades, asbestos removal, and household contact through workers' clothes
• Main results:
  • Citing UK data, there were 153 registered mesothelioma deaths in 1968 (the first complete year of the British register), rising to 1862 in 2002
  • Citing published predictions, UK mesothelioma deaths were expected to peak between 2011 and 2015 at 1950 to 2450 deaths per year
  • The authors stated that most or nearly all UK mesothelioma deaths are due to asbestos exposure
  • The authors stated that the latent period from first asbestos exposure to mesothelioma is seldom less than 15 years and can be as long as 60 years
  • The authors described median survival of about twelve months from diagnosis
  • Cited trial (Vogelzang et al.) of 456 patients with unresectable mesothelioma: cisplatin plus pemetrexed gave a longer median time to progression than cisplatin alone (5.7 months versus 3.9 months, P=0.001). The response rate was 41.3% (95% CI 34.8 to 48.1)
  • Cited randomized trial in 40 patients: radiotherapy to previous drain, aspiration or biopsy sites on the chest wall prevented growth of malignant nodules at those sites
  • Radical surgery (extrapleural pneumonectomy) as a single treatment had not been associated with any demonstrable increase in survival
  • In the authors' own earlier study, two contemporary series of patients given best supportive care had widely different survival curves, a larger difference than any claimed in therapy trials
  • The authors stated that the serum marker mesothelin rises with the bulk of disease, and that screening did not appear to them to be in patients' best interests until treatments are shown to make a difference
• The authors' conclusion: The authors concluded that trimodality treatment (chemotherapy, radical surgery and radiotherapy) is so demanding and selective that it can only be evaluated in a randomized controlled trial against the best alternative active treatment, analysed by intention to treat

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, Asbestos Exposure, Chemotherapy, Cisplatin, Pemetrexed (Alimta), Biopsy, Trimodality Therapy.

Related studies

• An Australian stocks and flows model for asbestos — S. Donovan, J. Pickin (2016)
• Using a Mobile Phone App to Identify and Assess Remaining Stocks of In Situ Asbestos in Australian Residential Settings — M. Govorko, L. Fritschi, et al. (2019)
• Evaluation of take home (para-occupational) exposure to asbestos and disease: a review of the literature — E.P. Donovan, B.L. Donovan, et al. (2012)
• Evaluation of take-home exposure and risk associated with the handling of clothing contaminated with chrysotile asbestos — J. Sahmel, C.A. Barlow, et al. (2014)
• Evaluation of take-home exposure to asbestos from handling asbestos-contaminated worker clothing following the abrasive sawing of cement pipe — A. Abelmann, J.R. Maskrey, et al. (2017)
• Pleural plaques related to "take-home" exposure to asbestos: An international case series — A. Peretz, V.C. Van Hee, et al. (2008)

Browse more research in Journal of the Royal Society of Medicine, or return to medical research.