Recurrence of malignant pleural mesothelioma at the resection borders--local or distant recurrence?

Our plain-English summary of Recurrence of malignant pleural mesothelioma at the resection borders--local or distant recurrence?, by D. Gomez, A. Tsao, D. Rice (Journal of Thoracic Oncology, 2013).

The study

• Authors: D. Gomez, A. Tsao, D. Rice
• Journal: Journal of Thoracic Oncology
• Published: 2013;8(7):e65-6
• Type of article: Letter, Comment
• Read it: PubMed · Publisher

In plain English

This is a letter to the editor, not a new study. The authors replied to a letter by Bölükbas, Eberlein and Schirren about the authors' earlier series of patients with malignant pleural mesothelioma treated with extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy. The letter writers had asked whether recurrences in the opposite side of the chest or in the abdomen, which lie at the resection borders, should be called local rather than distant. The authors agreed that classification here is difficult. They wrote that there is no way to determine with absolute certainty how these recurrences arise, so categorization relies on clinical judgment. They reported that most opposite-lung recurrences in their series were nodules inside the lung tissue rather than pleural-based, most probably from spread through the blood. Liver recurrences were all inside the liver tissue. They wrote that spread into the abdomen is common in this disease even without surgical breach of the diaphragm. They described their institution's rules for classifying recurrences, which they said aim to convey how disease progressed and to clarify options for salvage therapy.

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: Letter to the editor (authors' reply to a letter commenting on their earlier published study); no new data
• Who was studied: Patients with malignant pleural mesothelioma in the authors' earlier published series at their institution (MD Anderson Cancer Center, University of Texas, Houston). The reply gives no patient numbers.
• Exposure: No asbestos exposure is discussed. The letter concerns recurrence after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy.
• Main results:
  • Most recurrences in the opposite (contralateral) lung in the authors' series were tumor nodules within the lung tissue, not pleural-based. The authors considered these most probably due to spread through the blood.
  • Liver recurrences were exclusively within the liver tissue.
  • In the vast majority of cases the authors classified as distant recurrences, tumors were at sites not in direct continuity with the space left after pneumonectomy.
  • The authors stated that spread across the diaphragm into the abdominal cavity is a common feature of this disease even without the diaphragm being breached during surgery.
  • At the authors' institution, recurrence in the resection bed or at the resection margin above the diaphragm, or in the mediastinal lymph nodes, is classified as local-regional recurrence.
  • Disease away from the same-side chest or below the diaphragm, including opposite-lung nodules, abdominopelvic or peritoneal disease, and contralateral pleural disease, is classified as distant recurrence.
• The authors' conclusion: The authors stated that their classification aims both to convey the mechanism of progression and to clarify options for salvage therapy.
• Limitations the authors state:
  • The authors stated that there is no way to determine with absolute certainty the process underlying these recurrences.
  • Much of the categorization of recurrences for reporting relies on clinical judgment.

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.

Related studies

• Recurrence of malignant pleural mesothelioma at the resection borders--local or distant recurrence? — S. Bölükbas, M. Eberlein, et al. (2013)
• Patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesothelioma — D.R. Gomez, D.S. Hong, et al. (2013)
• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)
• Soluble Mesothelin-Related Peptides to Monitor Recurrence After Resection of Pleural Mesothelioma — B.M. Burt, H.S. Lee, et al. (2017)
• Clinical experience of volumetric modulated arc therapy for malignant pleural mesothelioma after extrapleural pneumonectomy — T. Kimura, Y. Doi, et al. (2015)
• Long-term outcomes of intensity-modulated radiotherapy following extra-pleural pneumonectomy for malignant pleural mesothelioma — Y. Matsuo, K. Shibuya, et al. (2017)

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