Pleural mesothelioma

Our plain-English summary of Pleural mesothelioma, by N. Martini, P.M. McCormack, M.S. Bains, et al (The Annals of Thoracic Surgery, 1987).

The study

• Authors: N. Martini, P.M. McCormack, M.S. Bains, L.R. Kaiser, M.E. Burt, B.S. Hilaris
• Journal: The Annals of Thoracic Surgery
• Published: 1987;43(1):113-20
• Type of article: Review
• Cited by: 77 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pleural mesotheliomas are uncommon tumors. Correct diagnosis of the benign variant is rarely made preoperatively, and resection is the treatment of choice and is curative. Malignant pleural mesotheliomas are locally aggressive and difficult to treat. They may be seen clinically as localized pleural tumors or as diffuse pleural disease with effusion and encasement of the lung and obliteration of the pleural space. The localized forms of malignant mesotheliomas are fibrosarcomatous. Their diagnosis and treatment do not differ from those for soft-part sarcomas seen elsewhere. Wide en-bloc excision is the treatment of choice and can be curative. The diffuse forms of malignant mesotheliomas are mainly epithelial. Treatment is generally unsatisfactory, and long-term survival is rare. Two surgical approaches are currently available: an extrapleural pneumonectomy and a pleurectomy with irradiation. The authors favor the latter approach because of its wider applicability, lower morbidity rate, and better survival advantage. Steps in selecting the best surgical mode of treatment are presented.

In plain English

This review of pleural mesothelioma, by surgeons and radiation oncologists at Memorial Sloan-Kettering Cancer Center in New York, combined published reports with the center's own patients. The center treated 226 pleural mesotheliomas from 1949 to 1985: 25 benign, 53 fibrosarcomatous and 148 epithelial or diffuse. All 16 fibrosarcomatous patients whose resection was incomplete or not possible died of their tumor 1 to 20 months from diagnosis. The 10 treated by complete resection were alive and well 1 to 10 years later. From 1972 to 1985, 109 patients with diffuse malignant mesothelioma had surgery. Thirteen could only be biopsied; none survived one year. For patients treated since 1976 with pleurectomy plus radiation, median survival was 21 months, one-year survival was 65% and two-year survival was 40%. Only 3 patients with diffuse disease were alive after five years. The article focused on treatment, not a new asbestos-exposure study; it stated exposure is noted in 40 to 50% of diffuse epithelial and 10% of fibrosarcomatous cases. The authors concluded they favored pleurectomy with radiation over extrapleural pneumonectomy, citing wider applicability, fewer complications and better survival.

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: Review article (a 'Current Review') that also reports the authors' own institutional treatment experience
• Who was studied: Patients with pleural mesothelioma treated at Memorial Sloan-Kettering Cancer Center, 1949 to 1985: 226 in total (25 benign, 53 fibrosarcomatous, 148 epithelial or diffuse). The surgical results focus on 109 patients with diffuse malignant mesothelioma explored from 1972 to 1985.
• Exposure: The article studied treatments: complete resection, pleurectomy with external and intraoperative radiation, and extrapleural pneumonectomy. It did not describe a new investigation of asbestos exposure and named no fiber types. It stated that asbestos exposure is mainly correlated with the diffuse epithelial type and is generally noted in 40 to 50% of those patients but in only 10% of patients with fibrosarcomatous mesothelioma. The article does not make clear whether these figures describe the center's own patients.
• Main results:
  • All 16 patients with advanced fibrosarcomatous pleural mesothelioma whose resection was incomplete or not possible died of their tumor 1 to 20 months from diagnosis (median 7 months).
  • The 10 fibrosarcomatous patients treated by complete resection remained alive and well 1 to 10 years after treatment.
  • Of the 109 diffuse malignant mesothelioma patients, 13 were unresectable and biopsied only. None of these 13 survived one year, and their median survival was four months.
  • Patients with diffuse mesothelioma treated by pleurectomy and radiation from 1976 onward had a median survival of 21 months, a one-year survival rate of 65% and a two-year survival rate of 40%.
  • There were no operative or postoperative deaths among the 94 patients treated by pleurectomy and radiation. There were 2 operative deaths among all 109 patients.
  • Extrapleural pneumonectomy was needed in 2 of 109 patients over the past 14 years.
  • Only 3 patients with diffuse mesothelioma in the authors' series were alive after five years.
• The authors' conclusion: The authors concluded that they favor pleurectomy with radiation over extrapleural pneumonectomy, because of its wider applicability, lower morbidity rate and better survival advantage. They recommend preserving functioning lung when possible. They also wrote that expectations for cure remain remote.

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, Malignant Mesothelioma, Sarcoma, Extrapleural Pneumonectomy (EPP).

Related studies

• Surgery for invasive primary mediastinal tumors — E.A. Bacha, A.R. Chapelier, et al. (1998)
• Laparoscopic thoracic duct clipping for persistent chylothorax after extrapleural pneumonectomy — N. Tsubokawa, Y. Hamai, et al. (2012)
• Laparoscopic repair of gastric herniation after extrapleural pneumonectomy for mesothelioma — M. Egan, B.E. Louie, et al. (2012)
• Surgical pathology of primary cardiac and pericardial tumors — C. Basso, M. Valente, et al. (1997)
• Primary tumors and cysts of the heart and pericardium — H.A. McAllister (1979)
• Soft tissue sarcomas of vulva — I. Davos, M.R. Abell (1976)

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