The management of malignant pleural mesothelioma; single centre experience in 10 years

Our plain-English summary of The management of malignant pleural mesothelioma; single centre experience in 10 years, by T. Aziz, A. Jilaihawi, D. Prakash (European Journal of Cardio-thoracic Surgery, 2002).

The study

• Authors: T. Aziz, A. Jilaihawi, D. Prakash
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2002;22(2):298-305
• Cited by: 101 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background And Objectives: Malignant pleural mesothelioma (MPM) is an asbestos-related disease of the pleura with a survival time without treatment ranging from 4 to 12 months. The objective of this study is to review our experience in selection of MPM patients for various modalities of treatment.

Methods: Between 1989 and 1998, 302 patients with MPM have been referred to our Centre for assessment. Majority (191 patients, 61%) of them received no specific treatment. Forty-seven patients were treated by decortication/pleurectomy and 64 had a radical extra-pleural pneumonectomy (EPP). Intrapleural chemotherapy and systemic post-operative chemotherapy was employed only in the last 51 patients following radical surgery.

Results: The average survival was 8.9 months for those treated by palliative care only. The average survival was 13 and 14 months for patients treated by radical surgery only or by decortication/pleurectomy, respectively. However, survival has improved to a mean of 35 months for patients treated by radical surgery followed by systemic post-operative chemotherapy. In this group, the survival prevalence was 90 and 70% for T1 patients and 85 and 36% for T2 patients at 1 and 3 years, respectively (P=0.002). Survival was surprisingly, not affected by lymph node involvement (P=0.08) or pathological type of MPM (P=0.07). The operative mortality was 9% for EPP and 0% for decortication/pleurectomy.

Conclusion: In selected patients with MPM, complete surgical resection by EPP represents an important initial step in their management. Systemic chemotherapy improves survival in surgically treated patients. Further trials are needed to improve on the adjuvant treatment regimes.

In plain English

This retrospective study from Hairmyres Hospital, Scotland, reviewed 302 patients with malignant pleural mesothelioma assessed between 1989 and 1999. A clear asbestos exposure history was documented in 288. Of the 302, 191 received only supportive care, with a median survival of 7 months. Another 47 had a lesser operation (decortication/pleurectomy). The remaining 64 had extra-pleural pneumonectomy (EPP), which removes the lung, its lining, and the diaphragm and heart sac on that side. The first 13 EPP patients had surgery alone. The next 51 also received carboplatin and epirubicin chemotherapy. This was not a randomised comparison. Six of 64 EPP patients died within 30 days of surgery, and there were no operative deaths after pleurectomy. Median survival was 13 months after EPP alone and 35 months after EPP with chemotherapy. The article's abstract gives an average survival of 14 months after pleurectomy. In the chemotherapy group, 9 of 51 survived beyond 5 years, and earlier tumour stage was linked to longer survival. The authors concluded that radical resection is an important first step whenever feasible and should be followed by adjuvant 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: Retrospective, non-randomised single-centre review of treatment and survival
• Who was studied: 302 patients with malignant pleural mesothelioma referred to Hairmyres Hospital, East Kilbride, Scotland, between 1989 and 1999 (the abstract says 1998); median age 57 years (range 34 to 77); 61 were women
• Exposure: Treatments compared: best supportive care only (191), decortication/pleurectomy (47), and EPP (64). Of the EPP patients, 13 had surgery alone and 51 also had post-operative intrapleural carboplatin plus systemic carboplatin and epirubicin. No asbestos fiber types are named.
• Main results:
  • A clear history of asbestos exposure was documented in 288 of the 302 patients. The median time between asbestos exposure and development of mesothelioma was 26 years (range 19 to 37 years).
  • Six of 64 EPP patients died within 30 days of the operation. The article prints this as 9.1%, but 6 of 64 works out to about 9.4%.
  • There were no operative deaths among the 47 pleurectomy/decortication patients.
  • Major complications occurred in 14 of 64 EPP patients (21%), including the six who died.
  • Patients given best supportive care only had a median survival of 7 months (range 1 to 19 months).
  • Survival did not differ significantly between EPP without chemotherapy (13 months) and decortication/pleurectomy (14 months).
  • The article's abstract describes the 13 months after EPP alone and the 14 months after decortication/pleurectomy as average survival.
  • After EPP with chemotherapy (51 patients), 1-year and 3-year survival were 84% and 48%, with a median survival of 35 months. After EPP without chemotherapy (13 patients), they were 49% and 0%, with a median of 13 months. The p-values were 0.001 at 1 year and 0.0001 at 3 years.
  • Nine of the 51 patients (18%) treated with EPP plus chemotherapy survived more than 5 years.
  • Among chemotherapy-treated EPP patients, median survival was 42.8 months for T1 tumours, 31 months for T2 and 14 months for T3. Survival at 1 and 3 years was 90% and 70% for T1 and 85% and 36% for T2.
  • There was no statistically significant survival difference between patients with and without lymph node spread (p = 0.08 at 3 years). Tumour cell type also showed no significant difference, though there was a trend favouring epithelial over sarcomatous tumours (p = 0.07).
  • After EPP alone, recurrence came after a median of 10 months, and 10 of 13 patients died within a median of 5 weeks of recurrence. After EPP with chemotherapy, median time to relapse was 37 months, and 31 of 51 patients recurred.
• The authors' conclusion: The authors concluded that radical surgical resection is an important first step in treating malignant pleural mesothelioma whenever feasible, that it should be followed by some form of adjuvant therapy, and that further trials of adjuvant regimes are needed.
• Limitations the authors state:
  • The study was retrospective and non-randomised.
  • Pleurectomy/decortication patients were not offered systemic chemotherapy.
  • The findings on lymph node spread and tumour cell type may need further studies to validate them. The authors suggest the node finding may reflect their small numbers.
  • There was no formal quality-of-life assessment after surgery or chemotherapy.
  • The choice between EPP and pleurectomy in some patients rested on the surgeon's subjective impression.

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, Pleura, Pneumonectomy, Chemotherapy, Palliative Care, Surgical Resection.

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