Overview of treatment related complications in malignant pleural mesothelioma

Our plain-English summary of Overview of treatment related complications in malignant pleural mesothelioma, by D.J. Murphy, R.R. Gill (Annals of Translational Medicine, 2017).

The study

• Authors: D.J. Murphy, R.R. Gill
• Journal: Annals of Translational Medicine
• Published: 2017;5(11):235
• Type of article: Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive malignant neoplasm of the pleura related to asbestos exposure. Despite recent advances in therapy for MPM, the prognosis remains poor, with considerable treatment associated morbidity. Radiological assessment plays a central role in the timely identification and subsequent management of treatment related complications in MPM. This review highlights common and uncommon complications associated with and encountered in the post treatment phase.

In plain English

This was a review article. The authors listed no data collection of their own. They described the treatments used for malignant pleural mesothelioma, a cancer of the lining of the lung that they described as related to asbestos exposure, and the complications those treatments can cause. Their focus was on how imaging such as chest X-ray, CT and MRI helps find these complications. The treatments covered were two main operations, extrapleural pneumonectomy (EPP) and extended pleurectomy/decortication (EP/D), plus radiotherapy, chemotherapy and newer therapies. The authors gathered complication rates reported in earlier published case series covering about 1,195 EPP and 800 EP/D patients. In those combined reports, heart rhythm problems occurred in 17.6% of patients after EPP and 7.4% after EP/D. Acute respiratory distress syndrome occurred in 4.9% and 0.8%, and empyema (infected fluid in the chest) in 3.7% and 0.4%. Prolonged air leak was more frequent after EP/D (about 6%) than after EPP (0.3%). The authors concluded that imaging can play a central role in identifying and managing treatment-related complications.

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 article; the authors list no data collection or data analysis of their own
• Who was studied: Patients with malignant pleural mesothelioma (MPM) treated with surgery, radiotherapy and/or chemotherapy, as described in published literature. The complication rates came from earlier published case series of about 1,195 EPP patients and 800 EP/D patients. Individual patient images were shown as illustrations.
• Exposure: Asbestos exposure was not studied. The 'exposures' reviewed were treatments for MPM: extrapleural pneumonectomy, extended pleurectomy/decortication, radiotherapy (including intensity-modulated radiotherapy), chemotherapy (cisplatin, pemetrexed, gemcitabine), heated intraoperative chemotherapy, photodynamic therapy, targeted therapy and immunotherapy.
• Main results:
  • In the combined published case series, the postoperative arrhythmia rate was 17.6% after EPP and 7.4% after EP/D
  • Acute respiratory distress syndrome (ARDS) had a cumulative reported incidence of 4.9% after EPP and 0.8% after EP/D
  • Empyema was reported in 3.7% of patients after EPP and 0.4% after EP/D
  • Prolonged air leak occurred in about 6% of EP/D cases and 0.3% of EPP cases
  • Venous thromboembolism had a cumulative reported incidence of 3.3% after EPP and 1.4% after EP/D
  • Bronchopleural fistula was reported in 2.3% of patients after EPP and 0.4% after EP/D
  • A meta-analysis cited by the authors (not their own work) reported higher short-term mortality after EPP than after EP/D (4.5% vs. 1.7%), with no difference in 2-year survival (24% vs. 25%)
  • Radiation pneumonitis usually occurred 1 to 6 months after radiotherapy and radiation fibrosis 6 to 12 months after. Cited data suggested an approximate 30% risk of radiation pneumonitis with intensity-modulated radiotherapy after EP/D.
• The authors' conclusion: The authors concluded that MPM treatments carry several complications that can cause significant illness, and that imaging can play a central role in identifying and managing them

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Neoplasm, Pleura, Asbestos Exposure, Prognosis.

Related studies

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• Subcutaneous seeding after ultrasound-guided placement of intrapleural catheter. An unusual complication of the intracavitary palliative treatment of pleural mesothelioma — S. Sartori, I. Nielsen, et al. (1999)
• Postoperative Complications Independently Predict Cancer-Related Survival in Peritoneal Malignancies — M.H.A. Choudry, Y. Shuai, et al. (2018)
• Intrapleural Fibrinolysis for the Treatment of Indwelling Pleural Catheter-Related Symptomatic Loculations: A Multicenter Observational Study — R. Thomas, F. Piccolo, et al. (2015)
• Surgical treatment of asbestos-related disease of the chest — L.P. Faber (1988)
• The economic costs of health service treatments for asbestos-related mesothelioma deaths — A. Watterson, T. Gorman, et al. (2006)

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