Pleural mesothelioma: clinical features and therapeutic implications

Our plain-English summary of Pleural mesothelioma: clinical features and therapeutic implications, by S.S. Legha, F.M. Muggia (Annals of Internal Medicine, 1977).

The study

• Authors: S.S. Legha, F.M. Muggia
• Journal: Annals of Internal Medicine
• Published: 1977;87(5):613-21
• Cited by: 150 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy.

Abstract

A detailed review of the literature was done to define the epidemiology, pathology, clinical features, and treatment of pleural mesothelioma. It appears that pleural mesothelioma accounts for approximately 400 deaths each year in the United States. Asbestos has been definitely implicated in the etiology of this disease. The common clinical features include chest pain, pleural effusion, and radiologic findings of irregular pleural thickening or pleural densities. Therapeutic modalities used in the past have included surgery, radiation therapy, and, more recently, chemotherapy. A combined modality approach to treatment appears more promising.

In plain English

This 1977 article was a review of published literature on pleural mesothelioma. It covered the disease's frequency, causes, microscopic appearance, symptoms, diagnosis and treatment. It focused mainly on the diffuse (spreading) form rather than the solitary form. The authors estimated about 400 deaths a year in the United States and wrote that asbestos had been definitely implicated as a cause. Pooling earlier reports, they found about 75% of pleural mesotheliomas were diffuse and 25% localized. Among 382 diffuse cases, 54% were epithelial, 25% mixed and 21% fibrosarcomatous. In 559 recent mesothelioma cases from tumor registries, which included both pleural and peritoneal tumors, men outnumbered women about 3 to 1. Among 193 patients, fluid around the lung was reported in 78%, chest pain in 69% and shortness of breath in 68%. For the diffuse form, the authors reported average survival of 12 to 15 months from first symptoms, with about 75% dying within a year of diagnosis. They concluded that no single treatment had proved superior and that combined treatment appeared more promising. They noted that the treatment studies were uncontrolled and that the incidence figures were likely underestimates.

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: literature review (with the authors' own pooling of previously published case series)
• Who was studied: Published reports and case series on pleural mesothelioma, concentrating on diffuse pleural mesothelioma; the solitary type was mentioned only where it differed
• Exposure: Asbestos, described as definitely implicated in the cause of the disease. The review named chrysotile, crocidolite, amosite and anthophyllite, and stated that all types had proved carcinogenic in humans, with some evidence that crocidolite may be the most potent.
• Main results:
  • The authors estimated that pleural mesothelioma accounted for approximately 400 deaths each year in the United States.
  • Pleural mesotheliomas: about 75% were the diffuse type and 25% solitary or localized (139 patients pooled in Table 1).
  • In the authors' compilation of 382 diffuse mesothelioma cases from the literature, 54% were epithelial, 25% mixed and 21% fibrosarcomatous.
  • In the authors' compilation of 559 recent mesothelioma cases from tumor registries (Table 2, which counts both pleural and peritoneal tumors), the ratio of men to women was 3:1.
  • Among 193 patients pooled from published series, chest pain was reported in 134 (69%), shortness of breath in 131 (68%) and pleural effusion in 150 (78%).
  • For diffuse pleural mesothelioma, average survival from onset of symptoms was 12 to 15 months.
  • For diffuse pleural mesothelioma, about 75% of patients died within 1 year after diagnosis, and average survival after diagnosis was 8 to 10 months.
  • The available treatment results did not show that any single treatment (surgery, radiotherapy or chemotherapy) was superior, and complete eradication of the tumor was infrequent with any of them.
• The authors' conclusion: The authors concluded that a combined approach to treatment appeared more promising than single treatments.
• Limitations the authors state:
  • The authors stated that the incidence figures they quoted were most likely underestimates.
  • The authors stated that none of the treatment studies they reviewed were controlled.
  • The authors stated that it was difficult to judge whether surgery prolonged survival in the uncontrolled surgical series.

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, Epidemiology, Pathology, Etiology, Pleural Effusion, Pleural Thickening, Chemotherapy.

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