Current Concepts: Malignant Mesothelioma

Our plain-English summary of Current Concepts: Malignant Mesothelioma, by H. Antman (1980).

The study

• Author: H. Antman
• Published: The New England Journal of Medicine, vol. 303, no. 4, July 23, 1980
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This article was a review of the epidemiology, natural history, pathology and treatment of malignant mesothelioma, published in The New England Journal of Medicine. It did not report a new study. Its figures came from earlier published series. The review stated that the share of mesothelioma patients exposed to asbestos ranged from 10 per cent in a midwestern United States series to 70 per cent in New England, England and South Africa. It also stated that increased risk had been documented in people living near asbestos mines and mills. It gave the overall ratio of pleural to peritoneal mesothelioma as about 3:1 and said no association between pericardial mesothelioma and asbestos exposure had been reported. Median survival in most reported series was four to 12 months after diagnosis. In one cited series, patients with Stage I, II and III disease survived a median of 16, nine and five months after diagnosis. The author concluded that an intensive combined approach of surgery, radiotherapy and doxorubicin-containing chemotherapy was investigational and should be attempted only in cooperation with an ongoing prospective clinical trial.

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: Review article ('Current Concepts') of published literature on malignant mesothelioma; no new patients were studied
• Who was studied: Previously published patient series and reports on malignant mesothelioma (pleural, peritoneal and pericardial), drawn from several countries
• Exposure: Asbestos in general (described as found in insulation, roofing and ceiling tiles, brake linings and small appliances). No specific fiber types are named. Occupational, 'bystander', residential and household exposure are discussed.
• Main results:
  • According to the reviewed series, the percentage of mesothelioma patients exposed to asbestos ranged from 10 per cent in a midwestern United States series to 70 per cent in New England, England and South Africa
  • The review stated that increased risk had been documented in persons living in areas surrounding asbestos mines and mills and in family members of asbestos workers
  • The overall ratio of pleural to peritoneal primary mesothelioma was given as about 3:1
  • Asbestosis (described as calcified pleural plaques and interstitial fibrosis) was said to be detectable in half the patients with peritoneal primary lesions but only 20 per cent of patients with pleural primary lesions
  • No association between pericardial mesothelioma and asbestos exposure had been reported
  • Median survival in most reported series was four to 12 months after diagnosis. In one cited series, Stage I, II and III patients survived a median of 16, nine and five months after diagnosis.
  • In a cited surgical series (Wanebo et al.), 7 of the 33 patients who had tumor resection were free of disease at 17 to 69 months (median 24)
  • In small numbers of patients, doxorubicin and alkylating agents including cyclophosphamide had response rates in the range of 20 to 40 per cent
• The authors' conclusion: The author concluded that combining surgery, radiotherapy and a doxorubicin-containing chemotherapy regimen may improve palliation and increase long-term disease-free survivors. The author added that such an intensive combined approach is investigational and should be attempted only in cooperation with an ongoing prospective clinical trial.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Epidemiology, Pathology, Peritoneal Mesothelioma, Pericardial Mesothelioma, Asbestos Exposure, Median Overall Survival, Doxorubicin.

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