The challenge of malignant pleural mesothelioma: new directions

Our plain-English summary of The challenge of malignant pleural mesothelioma: new directions, by V.W. Rusch, A. Rimner, L.M. Krug (Journal of Thoracic Oncology, 2014).

The study

• Authors: V.W. Rusch, A. Rimner, L.M. Krug
• Journal: Journal of Thoracic Oncology
• Published: 2014;9(3):271-2
• Type of article: Editorial, Comment
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This editorial, by authors from Memorial Sloan-Kettering Cancer Center, commented on two articles about the management of malignant pleural mesothelioma (MPM) published in the same journal issue. The first, by Bovolato et al., retrospectively analyzed outcomes in 1365 MPM patients treated at six Italian institutions over a 30-year period. The editorialists noted that it corroborated data from the IASLC International Staging and Prognostic Factors Committee, including the gap between clinical and pathological staging, the significance of tumor histology and patient age, and apparently better outcomes with combined modality therapy. They listed its strengths as the large number of patients, long follow-up and apparently uniform surgical approaches. They listed its limitations as variable adjuvant therapy, the long study duration and likely patient-selection biases. They also noted that outcomes could not be clearly distinguished between extrapleural pneumonectomy (EPP) and pleurectomy/decortication. The second article, by Cho et al. in Toronto, reported a phase II trial of immediate preoperative hemithoracic intensity-modulated radiation therapy followed by EPP. In highly selected patients this approach was associated with a 3-year overall survival of 84%. It did not seem to improve local control over postoperative radiation, and it was applicable to 18% of patients. The authors called for larger, preferably multicenter trials and formal guidelines for adjuvant chemotherapy. They concluded that future MPM trials need stricter inclusion criteria and strictly defined treatment in strictly defined patient cohorts.

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 article was a two-page editorial, not an original study, and it reported no new data of its own. It did not discuss asbestos exposure. The authors, from Memorial Sloan-Kettering Cancer Center, commented on two other articles in the same journal issue about treating malignant pleural mesothelioma. The first, by Bovolato and colleagues, retrospectively analyzed 1365 patients treated at six Italian institutions over a 30-year period. The editorial authors wrote that this study corroborated earlier data from the International Association for the Study of Lung Cancer. They noted limitations, including variable added (adjuvant) therapy and the long study period. They also found it difficult to identify differences in outcome between two operations, extrapleural pneumonectomy and pleurectomy/decortication. The second article, by Cho and colleagues in Toronto, tested radiation given immediately before extrapleural pneumonectomy. The editorial described it as associated with a 3-year overall survival of 84% in highly selected patients. In that group's experience the approach applied to 18% of patients. The authors concluded that future trials need to optimize patient selection.

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 two other articles; no original data
• Who was studied: No study population of its own. The editorial discussed two articles: an Italian retrospective analysis of 1365 malignant pleural mesothelioma patients, and a Toronto phase II trial
• Main results:
  • The editorial described the Italian study (Bovolato et al.) as covering six Italian institutions over a 30-year period
  • The authors' view: the Italian study corroborated data recently published by the IASLC International Staging and Prognostic Factors Committee
  • Limitations the editorial authors identified in the Italian study: variability in adjuvant therapy and the long duration of the study
  • The authors wrote that in the Italian study it was difficult to identify differences in outcome by surgical approach (extrapleural pneumonectomy versus pleurectomy/decortication)
  • The editorial reported that the Toronto study (Cho et al.) found preoperative radiation followed by extrapleural pneumonectomy was associated with a 3-year overall survival of 84% in highly selected patients
  • The authors wrote that the Toronto strategy did not seem to yield better local control than postoperative hemithoracic radiation after extrapleural pneumonectomy
  • According to the editorial, the Toronto approach was applicable to a minority of patients: 18% in that group's experience
  • The authors noted that adjuvant chemotherapy in the Toronto study was given in a very liberal time frame (less than 26 weeks after surgery)
• The authors' conclusion: The authors concluded that both studies emphasized the need to optimize patient selection in future mesothelioma trials, with more stringent inclusion criteria and strictly defined treatment studied prospectively

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: Pleural Mesothelioma, IASLC, Staging, Histology, Adjuvant Therapy, Selection Bias, Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D).

Related studies

• The Thoracic Surgery Service at Memorial Sloan Kettering Cancer Center — V.W. Rusch (2015)
• British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma — I. Woolhouse, L. Bishop, et al. (2018)
• Does surgery improve survival of patients with malignant pleural mesothelioma?: a multicenter retrospective analysis of 1365 consecutive patients — P. Bovolato, C. Casadio, et al. (2014)
• Malignant pleural mesothelioma and the Society of Thoracic Surgeons Database: an analysis of surgical morbidity and mortality — B.M. Burt, R.B. Cameron, et al. (2014)
• Thirty-day mortality underestimates the risk of early death after major resections for thoracic malignancies — R.R. McMillan, A. Berger, et al. (2014)
• Intraoperative fluorescence imaging in thoracic surgery — A.D. Newton, J.D. Predina, et al. (2018)

Browse more research in Journal of Thoracic Oncology, or return to medical research.