Multimodality treatment of pleural mesothelioma

Our plain-English summary of Multimodality treatment of pleural mesothelioma, by D.D. Shersher, M.J. Liptay (Surgical Oncology Clinics of North America, 2013).

The study

• Authors: D.D. Shersher, M.J. Liptay
• Journal: Surgical Oncology Clinics of North America
• Published: 2013;22(2):345-55
• Type of article: Review
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Although the treatment of malignant pleural mesothelioma has been refined during the past two decades, overall survival from this rather uncommon disease is still extremely poor. Here we review the current multimodal diagnostic and treatment options for patients with mesothelioma and discuss promising new experimental concepts in this disease.

Copyright © 2013 Elsevier Inc. All rights reserved.

In plain English

This article was a narrative review, not an original study. The authors summarized published research on diagnosing and treating malignant pleural mesothelioma, which they linked mainly to asbestos exposure. They covered surgery, chemotherapy, radiation, experimental drug and vaccine therapies, and blood biomarkers. A cited retrospective study of 663 patients found a modest survival advantage for pleurectomy/decortication over extrapleural pneumonectomy. A cited single-institution study reported a median survival of 20 months with chemoradiation added to surgery, versus 10 months for surgery alone. Two cited phase III trials linked adding an antifolate to cisplatin with a 2.6- to 2.8-month gain in median overall survival. The authors stated that radiation gives no survival advantage. Outside clinical trials, they said it is recommended only for chest wall pain from recurrence. They reported that a cited meta-analysis found serum mesothelin had 32% sensitivity (95% CI, 26% to 40%) for detecting mesothelioma at a 95% specificity threshold. The authors concluded that patients able to undergo surgery should receive surgical debulking plus chemotherapy, with or without radiotherapy for local recurrence. They also concluded that biologic and vaccine therapies remain experimental.

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 on the diagnosis and multimodality treatment of malignant pleural mesothelioma (no original data)
• Who was studied: No study population of its own. The authors reviewed published studies of patients with malignant pleural mesothelioma (24 references).
• Exposure: Asbestos was not studied directly. The review states that mesothelioma is mainly linked to asbestos exposure, with a latency period of 20 to 40 years. It also mentions blue asbestos exposure at Wittenoom, Australia, and other suggested causes (ionizing radiation, simian virus 40, a gene in some Turkish families).
• Main results:
  • In a cited multi-institutional retrospective study of 663 patients (Flores and colleagues), pleurectomy/decortication showed only a modest survival advantage over extrapleural pneumonectomy. The figure was a hazard ratio of 1.4, P<.01 for EPP, after controlling for stage, histology, gender and multimodal therapy.
  • In a cited single-institution analysis of 945 patients with mesothelioma (Flores and colleagues), median survival was 20 months when multimodal therapy (chemoradiation) was added to surgery, compared with 10 months for surgery alone.
  • The review states that both operations (pleurectomy/decortication and extrapleural pneumonectomy) now carry a 4% to 5% operative mortality rate and a 50% rate of operative morbidity at 30 days.
  • In two cited phase III randomized trials (Vogelzang and colleagues; Van Meerbeeck and colleagues), adding an antifolate (pemetrexed or raltitrexed) to cisplatin corresponded to a 2.6- to 2.8-month improvement in median overall survival compared with cisplatin alone.
  • The authors stated that radiation therapy currently provides no survival advantage. They listed its benefits as local tumor control and relief of chest wall pain.
  • Until more clinical trial data are available, the authors stated that current recommendations for radiation are restricted to palliation of chest wall pain caused by tumor recurrence, unless the patient is enrolled in a clinical trial.
  • In a cited meta-analysis of 16 diagnostic studies (Hollevoet and colleagues), serum mesothelin had a sensitivity of 32% (95% CI, 26% to 40%) for detecting mesothelioma at a 95% specificity threshold.
  • In a cited study by Pass and colleagues, which the authors described as underpowered, serum osteopontin detected mesothelioma in a subgroup of patients with known asbestos exposure, with sensitivity 77.6 and specificity 85.5.
• The authors' conclusion: The authors concluded that, after tissue diagnosis, treatment should include surgical debulking combined with chemotherapy (cisplatin or carboplatin with an antifolate), with or without radiotherapy for local recurrence. The operation would be extrapleural pneumonectomy or pleurectomy/decortication, depending on institutional experience and patient tolerance. Elsewhere they described surgical resection as a first-line option for patients who meet preoperative criteria, and palliative procedures for those who are not resection candidates. They concluded that biologic and vaccine therapies are still experimental, and that mesothelin and osteopontin are likely most useful for monitoring relapse after treatment.
• Limitations the authors state:
  • The authors noted that randomized controlled data showing one operation is superior to the other for non-palliative resection are lacking. They also noted that the retrospective studies comparing the operations were poorly matched.

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, Overall Survival, Mesothelioma.

Related studies

• An overview of neoadjuvant chemotherapy in the multimodality treatment of malignant pleural mesothelioma — G. Pasello, G.L. Ceresoli, et al. (2013)
• 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)
• Multimodality treatment of diffuse malignant pleural mesothelioma — L.S. Zellos, D.J. Sugarbaker (2002)
• 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)

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