Radical surgery for mesothelioma

Our plain-English summary of Radical surgery for mesothelioma, by T. Treasure, D. Waller, S. Swift, et al (BMJ, 2004).

The study

• Authors: T. Treasure, D. Waller, S. Swift, J. Peto
• Journal: BMJ
• Published: 2004;328(7434):237-8
• Type of article: Editorial
• Cited by: 43 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Summary of the article

This editorial discussed the growing epidemic of malignant pleural mesothelioma and the place of radical surgery in managing it. The authors stated that one in every hundred men born in the 1940s would die of the disease, which is almost exclusively a consequence of asbestos exposure, with a lag time rarely under 25 years and often over 50 years. Britain had over 1800 deaths per year. Because UK exposure continued until 1980, the peak was expected in 2015 to 2020 at about 2000 deaths per year. About 25% of deaths were expected in men who had worked in the building industry, with carpenters and joiners most commonly affected, and about 90% were attributed to exposure in unmonitored settings. The authors described the difficulty of diagnosis and noted that median survival from diagnosis was usually under a year. Extrapleural pneumonectomy, usually given as part of trimodality treatment, had been associated with five-year survival of up to 48% in highly selected patients with epithelioid histology and no lymph node metastases. Only about 20 patients per year had received radical surgery in the UK. A pilot feasibility study, the MARS trial, was under way, and a full trial would need 670 patients over three years with five years' follow-up. The authors recommended early diagnosis, thoracoscopic talc pleurodesis combined with surgical biopsy, staging, and treatment within studies.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This item is an editorial that reports no new data. The authors argued that Britain's epidemic of malignant pleural mesothelioma had not yet peaked. Citing other sources, they wrote that there were over 1800 deaths per year in Britain. They also wrote that the peak was expected in 2015 to 2020, at about 2000 deaths per year in the United Kingdom. They described radical surgery (extrapleural pneumonectomy): removal of the whole lung on one side with the parietal pleura, pericardium and diaphragm. In other series, the operation, usually part of trimodality treatment with chemotherapy and radiotherapy, was associated with five-year survival of up to 48%, but only in highly selected subsets of patients with epithelioid histology and no lymph node metastases. In the UK the operation had averaged only 20 patients per year over the past five years. A pilot trial (MARS) was under way, and answering the question would need 670 patients. The authors concluded that doctors should recognise the disease early, treat it actively, and learn the best treatment through carefully designed studies.

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 (opinion piece); no original data. Figures are cited from other publications.
• Who was studied: No study population. The editorial discusses patients with malignant pleural mesothelioma, mainly in Britain and the United Kingdom, with brief mention of Europe, Australia, the United States and the developing world.
• Exposure: Asbestos in general. No fiber types are named. The editorial mentions insulation work, the building industry (carpenters and joiners most commonly afflicted, according to Health and Safety Executive statistics), do-it-yourself home improvements, and wives and daughters who washed asbestos workers' overalls.
• Main results:
  • The editorial cited over 1800 mesothelioma deaths per year in Britain, about one in 200 of all deaths in men and one in 1500 in women. These figures come from other sources.
  • The editorial stated that the peak of the epidemic was expected in 2015 to 2020, when the death rate was likely to be 2000 per year in the United Kingdom.
  • Citing other series, the editorial stated that extrapleural pneumonectomy, usually considered as part of trimodality treatment with chemotherapy and radiotherapy, was associated with survival figures of up to 48% at five years. This applied only in highly selected subsets of patients with the more favourable epithelioid (as opposed to sarcomatoid) histology and no lymph node metastases.
  • The editorial stated that radical surgery had been performed in the United Kingdom on an average of only 20 patients per year in the past five years.
  • The editorial stated that a pilot feasibility study (the MARS trial, funded by Cancer Research UK) was under way. Answering the question would require 670 patients over three years with five years' follow up, giving an answer by about 2012.
  • The editorial stated that median survival from diagnosis is usually under a year, but that individual series vary markedly.
• The authors' conclusion: The authors concluded that the disease cannot now be prevented in workers exposed in the 1950s to 1970s. In their view, doctors can recognise it early, treat it actively, and learn about the best treatment through carefully thought out studies. They recommended that extrapleural pneumonectomy for early-stage disease, and chemotherapy for inoperable disease, be given within studies.

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, Pleural Mesothelioma, Asbestos Exposure, Median Survival, Extrapleural Pneumonectomy (EPP), Epithelioid, Histology, Talc Pleurodesis.

Related studies

• Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study — T. Treasure, L. Lang-Lazdunski, et al. (2011)
• Radical surgery for mesothelioma: how can we obtain evidence? — T. Treasure, S. Swift, et al. (2003)
• Predictors of long-term survival following radical surgery for malignant pleural mesothelioma — A. Nakas, D. Waller (2014)
• The new case for cervical mediastinoscopy in selection for radical surgery for malignant pleural mesothelioma — A. Nakas, D. Waller, et al. (2012)
• Pretreatment serum C-reactive protein levels predict benefit from multimodality treatment including radical surgery in malignant pleural mesothelioma: a retrospective multicenter analysis — B. Ghanim, M.A. Hoda, et al. (2012)
• Comorbidity, postoperative morbidity and survival in patients undergoing radical surgery for malignant pleural mesothelioma — M. Infante, E. Morenghi, et al. (2016)

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