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

Our plain-English summary of 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, by V. Rusch, E.H. Baldini, R. Bueno, et al (The Journal of Thoracic and Cardiovascular Surgery, 2013).

The study

• Authors: V. Rusch, E.H. Baldini, R. Bueno, M. De Perrot, R. Flores, S. Hasegawa, W. Klepetko, L. Krug, L. Lang-Lazdunski, H. Pass, W. Weder, D.J. Sugarbaker, participants in the 2012 International Mesothelioma Interest Group Congress
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2013;145(4):909-910
• Cited by: 120 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This article summarized discussions at the International Mesothelioma Interest Group (IMIG) Congress, held September 11-14, 2012, in Boston, on the role of surgical cytoreduction, extrapleural pneumonectomy (EPP) or extended pleurectomy/decortication (P/D), in treating malignant pleural mesothelioma (MPM). More than 500 participants from the involved specialties took part. The authors described shortcomings of the Mesothelioma and Radical Surgery (MARS) I feasibility trial. Its survival analysis used fewer than 10% of the required sample size. Protocol compliance was poor: 6 of 26 no-EPP patients had off-protocol surgery, and only 16 of 24 EPP-group patients underwent EPP. EPP-associated morbidity (69%) and mortality (19%) were higher than in the literature. The authors concluded that no conclusions about the efficacy of EPP could be drawn from MARS I. Presentations at the meeting reaffirmed that recurrence is primarily local. Six institutional series from the US, Europe and Japan reported median survival of 25 to 37 months for patients with epithelial disease and negative extrapleural lymph nodes, with operative mortality of 0% to 2%. A preliminary IASLC staging analysis showed 19-month median survival among 1359 patients undergoing resection, and a median of 40 months after EPP for early-stage disease. Attendees agreed on several points. Surgery aiming at macroscopic complete resection should be part of multimodality therapy, with the type chosen on clinical factors and surgical judgment. Patients should be evaluated in a multidisciplinary setting, with clinical staging and histologic subtyping done before therapy.

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 not a research study. It was a summary of discussions at the International Mesothelioma Interest Group (IMIG) Congress in Boston, September 11-14, 2012. There, more than 500 participants reviewed surgery for malignant pleural mesothelioma: extrapleural pneumonectomy (EPP) and extended pleurectomy/decortication (P/D). It did not examine asbestos exposure. The authors criticized the earlier MARS I trial. They said protocol compliance was poor and that EPP-associated morbidity of 11/16 (69%) and mortality of 3/16 (19%) were much higher than reported in the literature. They also summarized work presented by others. Six institutional series reported median survival of 25 to 37 months for patients with epithelial disease and negative extrapleural lymph nodes, with operative mortality of 0% to 2%. A preliminary analysis of the IASLC registry showed a 19-month median survival among 1359 patients with epithelial disease who had surgical resection. IMIG members concluded that surgery, whether P/D or EPP, aimed at macroscopic complete resection should be performed as part of multimodality treatment.

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: meeting summary of an expert congress (published as clinical guidelines), reporting critiques of other studies and consensus points; not original research
• Who was studied: more than 500 participants from the involved specialty groups at the IMIG Congress, Boston, September 11-14, 2012; the article has no patient population of its own
• Main results:
  • In the MARS I trial (another study, critiqued here), 16 of 24 patients assigned to EPP actually underwent EPP, and 6 of 26 in the no-EPP group had off-protocol surgery
  • In MARS I, EPP-associated morbidity was 11/16 (69%) and mortality 3/16 (19%), which the authors said were much higher than reported in the literature
  • Six institutional series presented at the meeting (by other investigators) reported median survival of 25 to 37 months for patients with epithelial disease and negative extrapleural lymph nodes, with operative mortality of 0% to 2%
  • A preliminary analysis of the IASLC worldwide registry of patients with epithelial malignant pleural mesothelioma (presented at the meeting, published separately) showed a 19-month median survival among 1359 patients undergoing surgical resection (P/D or EPP)
  • In the IASLC analysis, patients undergoing EPP for early-stage disease had a median survival of 40 months, superior to all other subgroups
• The authors' conclusion: IMIG members concluded that surgery, whether P/D or EPP, with the goal of macroscopic complete resection should be performed as part of multimodality treatment of malignant pleural mesothelioma

Topics

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

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, Pleural Mesothelioma, Mesothelioma, IMIG, Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D), Median Overall Survival, IASLC.

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• Imaging in pleural mesothelioma: a review of imaging research presented at the 9th International Meeting of the International Mesothelioma Interest Group — A.K. Nowak, S.G. Armato, et al. (2010)
• The role of radiation treatment in pleural mesothelioma: Highlights of the 14th International Conference of the International mesothelioma interest group — R.M. MacRae, M. Ashton, et al. (2019)
• 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)
• Long-term survival after lung-sparing total pleurectomy for locally advanced (International Mesothelioma Interest Group Stage T3-T4) non-sarcomatoid malignant pleural mesothelioma — A. Nakas, E. von Meyenfeldt, et al. (2012)

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