Reply to Waller et al. Standardizing Surgical Treatment for Mesothelioma

Our plain-English summary of Reply to Waller et al. Standardizing Surgical Treatment for Mesothelioma, by J.S. Friedberg, M.J. Culligan, A.S. Tsao, et al (Journal of Thoracic Oncology, 2020).

The study

• Authors: J.S. Friedberg, M.J. Culligan, A.S. Tsao, V. Rusch, P.S. Adusumilli, B. Sepesi, H.I. Pass, R. Bueno, B. Burt, D.J. Sugarbaker, M. de Perrot, A.A. Adjei, F.R. Hirsch, S.M. Malik, D.J. Harpole
• Journal: Journal of Thoracic Oncology
• Published: 2020;15(5):e75-e77
• Type of article: Letter, Comment
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is not a research study. It is a letter to the editor in which a North American task force replied to comments by Waller et al. on the task force's earlier article proposing a system toward standardizing surgery-based treatment for malignant pleural mesothelioma. The authors said the information needed to declare the correct way to do this operation did not yet exist, and that the approach used in the MARS2 trial had not been established as the correct one. They stated that they do not advocate leaving behind visible or gross disease, including on the diaphragm. They said the view that the entire visceral pleura must always be removed en bloc was an opinion, not an approach supported by definitive evidence. In support, they cited a 2020 conference presentation by the lead author and colleagues on 37 patients with epithelioid mesothelioma who had lung-sparing surgery. That presentation reported no difference in overall or disease-free survival by how the visceral pleura was treated. The authors said this was not definitive evidence. They called for prospective, standardized recording of operations and for international collaboration.

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 (a reply to a letter from Waller et al. about the authors' earlier article); no new data were collected
• Main results:
  • The authors stated that the information needed to declare the correct way to perform surgery for malignant pleural mesothelioma does not yet exist.
  • The authors stated that they do not advocate leaving visible disease on any part of the parietal pleura, including the diaphragm.
  • The authors stated that they do not advocate leaving gross disease, and that their article did not reference the MARS2 trial.
  • The authors called Waller et al.'s position that the entire visceral pleura should be removed en bloc in every case an opinion, not an approach backed by definitive evidence.
  • In a separate conference presentation the authors cited (not this letter's own data), 37 patients with epithelioid mesothelioma had lung-sparing surgery. In 23 of 37 the visceral pleura was removed en bloc. In 14 of 37 it was partly to fully cauterized.
  • In that cited presentation, the 37 patients had not reached median overall survival at 5 years. There was no difference in overall or disease-free survival between the surgery-alone group and the cauterization with or without surgery group. The authors said this was not definitive evidence.
• The authors' conclusion: The authors concluded that the surgical standard of care for lung-sparing mesothelioma surgery remains a work in progress. They argued that operative details should be recorded prospectively and in a standardized way, through international collaboration, so that what works best can eventually be determined. They noted a planned International Mesothelioma Interest Group workshop on a web-based data collection system.
• Limitations the authors state:
  • The authors restated a limitation from their earlier article: all of its authors were from North America, which might not fully match the views of mesothelioma surgeons elsewhere.

Topics

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

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

Related studies

• A Proposed System Toward Standardizing Surgical-Based Treatments for Malignant Pleural Mesothelioma, From the Joint National Cancer Institute-International Association for the Study of Lung Cancer-Mesothelioma Applied Research Foundation Taskforce — J.S. Friedberg, M.J. Culligan, et al. (2019)
• Standardizing Surgical Treatment of Malignant Pleural Mesothelioma — D.A. Waller, R. Bilancia, et al. (2020)
• Current and Future Management of Malignant Mesothelioma: A Consensus Report from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation — A.S. Tsao, O.W. Lindwasser, et al. (2018)
• The Use of Radiation Therapy for the Treatment of Malignant Pleural Mesothelioma: Expert Opinion from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation — D.R. Gomez, A. Rimner, et al. (2019)
• Radiologic Considerations and Standardization of Malignant Pleural Mesothelioma Imaging Within Clinical Trials: Consensus Statement from the NCI Thoracic Malignancy Steering Committee - International Association for the Study of Lung Cancer - Mesothelioma Applied Research Foundation Clinical Trials Planning Meeting — R.R. Gill, A.S. Tsao, et al. (2019)
• The role of surgical cytoreduction in the treatment of malignant pleural mesothelioma: meeting summary of the International Mesothelioma Interest Group Congress, September 11-14, 2012, Boston, Mass — V. Rusch, E.H. Baldini, et al. (2013)

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