Pleural IMRT after Lung-Sparing Cytoreduction for Mesothelioma: Mature Enough to Randomize

Our plain-English summary of Pleural IMRT after Lung-Sparing Cytoreduction for Mesothelioma: Mature Enough to Randomize, by H.I. Pass (Journal of Thoracic Oncology, 2017).

The study

• Author: H.I. Pass
• Journal: Journal of Thoracic Oncology
• Published: 2017;12(6):919-921
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher

In plain English

This article is an editorial, a commentary by one author, not a research study; it reports no new patient data. It discussed a report by Shaikh and colleagues on intensity-modulated radiation therapy (IMRT) to the pleura after lung-sparing surgery for pleural mesothelioma. The author wrote that safe delivery of this radiation was no longer in question, though it depends on the center's expertise, and that in that report pneumonitis could lead to death in 2% to 3% of patients receiving IMRT. The author cited that report's 20.2-month median survival from completion of radiation in 78 patients, compared it with other studies, and asked whether the results might reflect patient selection. The author described wide variation in how these treatments are given and reported. The author was still unsure how much pleural IMRT adds to overall survival. The author concluded that there is a promising efficacy signal but that a randomized trial is needed to work out which patients should receive it, when, and what other treatment to give besides surgery. Asbestos exposure was not discussed.

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: Editorial (single-author commentary on another group's report); no original data
• Who was studied: No study population of its own. The editorial comments on a report by Shaikh et al. (Rimner's group) describing a cohort of 78 patients with pleural mesothelioma.
• Exposure: Not an asbestos exposure study. The subject is a treatment: pleural intensity-modulated radiation therapy (IMRT) after lung-sparing maximal cytoreductive surgery for pleural mesothelioma.
• Main results:
  • Not a finding of this editorial. The author cites the Shaikh et al. report: pneumonitis after IMRT could lead to death in 2% to 3% of patients receiving it.
  • Not a finding of this editorial. The author cites a 20.2-month median survival, measured from completion of radiation, in the 78-patient cohort of Rimner's group.
  • The author states uncertainty about how much pleural IMRT adds to overall survival.
  • The author questions whether such results may be due to patient selection, because patients suitable for lung-sparing surgery usually have lower-volume disease.
  • The author states that variability in how lung-sparing multimodality treatments are conducted and reported makes consensus on a standard regimen impossible.
• The authors' conclusion: The author concluded that there is a promising efficacy signal with pleural IMRT. The author added that it is unclear which patients should receive it, when, and what else to give besides surgery, and that a randomized trial is needed to answer these questions.

Topics

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

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, Mesothelioma.

Related studies

• Improved Outcomes with Modern Lung-Sparing Trimodality Therapy in Patients with Malignant Pleural Mesothelioma — F. Shaikh, M.G. Zauderer, et al. (2017)
• Moderately Hypofractionated Helical IMRT, FDG-PET/CT-guided, for Progressive Malignant Pleural Mesothelioma in Patients With Intact Lungs — A. Fodor, S. Broggi, et al. (2019)
• Disease-Related Outcomes and Toxicities of Intensity Modulated Radiation Therapy After Lung-Sparing Pleurectomy for Malignant Pleural Mesothelioma: A Systematic Review — R. Patel, E.B. Ludmir, et al. (2020)
• Optimal gross tumor volume definition in lung-sparing intensity modulated radiotherapy for pleural mesothelioma: an in silico study — A. Botticella, G. Defraene, et al. (2016)
• A feasibility study evaluating Surgery for Mesothelioma After Radiation Therapy: the "SMART" approach for resectable malignant pleural mesothelioma — B.C. Cho, R. Feld, et al. (2014)
• Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma — M. de Perrot, R. Feld, et al. (2016)

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