Primum non nocere? Does this also apply to mesothelioma?

Our plain-English summary of Primum non nocere? Does this also apply to mesothelioma?, by P. Baas (Lung Cancer, 2012).

The study

• Author: P. Baas
• Journal: Lung Cancer
• Published: 2012;77(1):1
• Type of article: Editorial
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This one-page editorial reported no new research. It commented on a same-issue paper by Rena and Casadio on surgery for malignant pleural mesothelioma (MPM). The author listed weaknesses of earlier retrospective surgical studies, including strict patient selection, exclusion of non-epithelial tumors, non-standard operations and varied added treatments. As the author summarized it, Rena and Casadio analyzed 423 patients over ten years, of whom 77 were early stage. Of these 77, 40 were candidates for extra pleural pneumonectomy (EPP) and 37 for pleurectomy/decortication (P/D). Mortality was 5% and morbidity 62% in the EPP group, against 0% and 24% in the P/D group. Median overall survival was 20 months for EPP and 25 months for P/D, not a significant difference; this analysis excluded two EPP patients who died after surgery. Quality-of-life questionnaires showed a significant gain with P/D, though numbers were small. The author noted the paper gave little detail on chemotherapy, radiation and toxicity. The author concluded that the trend is to perform EPP only when P/D is not possible or within a study, while surgery still has a place.

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 commenting on a retrospective single-centre study by Rena and Casadio published in the same journal issue; no original data
• Who was studied: As described in the editorial, the Rena and Casadio study covered 423 patients with malignant pleural mesothelioma over ten years. Of these, 174 had epithelial MPM and 77 were considered early stage (stages I and II). Of the 77 early-stage patients, 40 were EPP candidates and 37 were P/D candidates. Location is not given.
• Exposure: No asbestos exposure was discussed. The editorial concerns surgical treatment: extra pleural pneumonectomy after induction chemotherapy, with post-operative hemi-thorax radiation when possible, compared with pleurectomy/decortication with neo-adjuvant chemotherapy and irradiation to the surgical scar.
• Main results:
  • In the Rena and Casadio study (as reported by the editorial), mortality was 5% and morbidity 62% in the EPP group, compared with 0% mortality and 24% morbidity in the P/D group.
  • In the Rena and Casadio study, median overall survival was 20 months for EPP and 25 months for P/D, not a significant difference. Two EPP patients were excluded from this analysis because of post-operative death.
  • In the Rena and Casadio study, quality-of-life questionnaires taken at 6 and 12 months after treatment indicated a significant gain in the P/D group, although the numbers were small.
  • The author stated that earlier surgical studies in mesothelioma were single-arm and retrospective, and that patient selection for surgery is very strict: an estimated 1 out of 12 patients are considered candidates for a visit to the surgeon.
• The authors' conclusion: The author concluded that, grouping the studies reported so far, there is a strong trend to perform EPP only when P/D is not possible or as part of a study. The author added that many still feel surgery should be included in treating MPM, both for tumor reduction and to obtain research material.
• Limitations the authors state:
  • The author stated that patient selection, exclusion of non-epithelial histology and lack of a standard resection are issues for the Rena and Casadio study.
  • The author stated that the Rena and Casadio study gave only marginal information on the type of chemotherapy, responses to induction therapy, type of radiation therapy and duration of toxicity. The author suggested these may be minor problems because it was a single-centre study.

Topics

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

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

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