Multimodality treatment of diffuse malignant pleural mesothelioma

Our plain-English summary of Multimodality treatment of diffuse malignant pleural mesothelioma, by L.S. Zellos, D.J. Sugarbaker (Seminars in Oncology, 2002).

The study

• Authors: L.S. Zellos, D.J. Sugarbaker
• Journal: Seminars in Oncology
• Published: 2002;29(1):41-50
• Type of article: Review
• Cited by: 56 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Diffuse malignant pleural mesothelioma (DMPM) is a challenging disease in all of its aspects, from presentation and diagnosis to staging and treatment. Single-modality therapy was the initial approach to this disease. It generally has not been effective in changing the natural history of DMPM. As a result, multimodality regimens involving surgery with radiation, chemotherapy, or immunotherapy delivered regionally or systemically have been evaluated. Randomized controlled studies comparing various strategies are lacking and, thus, the debate continues regarding the effectiveness of different treatment approaches.

Copyright 2002 by W.B. Saunders Company.

In plain English

This article was a review of treatments for diffuse malignant pleural mesothelioma, a cancer of the lining of the chest. It did not study asbestos exposure. Asbestos came up only as a reason to suspect the disease. The authors described diagnosis, staging, and single treatments, then reviewed published series that combined surgery with other treatments. One series from Brigham and Women's Hospital and the Dana-Farber Cancer Institute (DFCI) included 183 patients who had extrapleural pneumonectomy, an operation removing the lung and the surrounding lining, between 1980 and 1997. Seven died around the time of surgery (3.8%). Of the 176 survivors, who went on to chemotherapy and radiation, 38% were alive at 2 years and 15% at 5 years. Those with epithelial tumors and stage I disease had a median survival of 51 months. The authors noted that randomized studies comparing strategies were lacking. They concluded that treatment must be tailored to stage and tumor subtype. They said the reviewed studies showed a trend toward better survival in early-stage disease, but patients with advanced disease had not shared this benefit.

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 diagnosis, staging, and single-modality and multimodality treatment of diffuse malignant pleural mesothelioma
• Who was studied: No new patients were studied. The review covered published treatment series of patients with diffuse malignant pleural mesothelioma, including 183 patients treated at Brigham and Women's Hospital and DFCI (1980 to 1997) and 105 patients treated at Memorial Sloan-Kettering (1976 to 1988).
• Exposure: Asbestos exposure was not studied. It was mentioned only as a reason for suspicion when diagnosing the disease. No fiber types were discussed.
• Main results:
  • In the Brigham and Women's/DFCI series, 183 patients underwent extrapleural pneumonectomy between 1980 and 1997, and 7 died perioperatively (mortality rate 3.8%).
  • The 176 patients who survived surgery in that series had 2-year and 5-year survival rates of 38% and 15%.
  • In that series, the subset with epithelial histology and stage I disease (negative lymph nodes and negative margins) had a median survival of 51 months, with 2-year and 5-year survival rates of 68% and 46%.
  • Among the 176 patients, the revised Brigham/DFCI staging system separated survival by stage (P = .0011). The Butchart system (P = .09) and the IMIG system (P = .31) did not.
  • In a subset of 46 evaluable patients from the trimodality series reviewed for patterns of failure, ipsilateral chest recurrence was seen in 35% and abdominal recurrence in 26%.
  • In the Memorial Sloan-Kettering series of 105 patients treated with pleurectomy/decortication, brachytherapy and external-beam radiation, 1-year and 2-year overall survival rates were 52% and 23%.
  • In the Memorial Sloan-Kettering trial of pleurectomy/decortication with intrapleural and systemic chemotherapy, 16 of 20 patients (80%) had locoregional recurrence.
  • In a phase III study by Pass et al, median survival did not differ between patients who received intraoperative photodynamic therapy and those who did not (14.4 vs 14.1 months).
• The authors' conclusion: The authors concluded that treatment must be tailored to stage and histologic subtype. In their view, the studies show a trend toward improved survival in early-stage disease, while patients with advanced disease have not had this benefit from multimodality regimens.
• Limitations the authors state:
  • Randomized controlled studies comparing treatment strategies are lacking.
  • The retrospective surgical studies use different staging systems and do not always group patients by stage.
  • No staging system is universally accepted, and the IMIG system has not been validated.

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, Staging, Chemotherapy, Immunotherapy.

Related studies

• Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma — D.J. Sugarbaker, G.M. Strauss, et al. (1993)
• Multimodality treatment of malignant pleural mesothelioma with or without immunotherapy: does it change anything? — M. Lucchi, A. Picchi, et al. (2010)
• A New Prognostic Score Supporting Treatment Allocation for Multimodality Therapy for Malignant Pleural Mesothelioma: A Review of 12 Years' Experience — I. Opitz, M. Friess, et al. (2015)
• Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma — A. Kostron, M. Friess, et al. (2016)
• Pretreatment serum C-reactive protein levels predict benefit from multimodality treatment including radical surgery in malignant pleural mesothelioma: a retrospective multicenter analysis — B. Ghanim, M.A. Hoda, et al. (2012)
• Multimodality treatment of malignant pleural mesothelioma — L. Berzenji, P. Van Schil (2018)

Browse more research in Seminars in Oncology, or return to medical research.