Malignant pleural disease

Our plain-English summary of Malignant pleural disease, by L.M. Piggott, C. Hayes, J. Greene, et al (Breathe, 2023).

The study

• Authors: L.M. Piggott, C. Hayes, J. Greene, D.B. Fitzgerald
• Journal: Breathe
• Published: 2023;19(4):230145
• Type of article: Review
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural disease represents a growing healthcare burden. Malignant pleural effusion affects approximately 1 million people globally per year, causes disabling breathlessness and indicates a shortened life expectancy. Timely diagnosis is imperative to relieve symptoms and optimise quality of life, and should give consideration to individual patient factors. This review aims to provide an overview of epidemiology, pathogenesis and suggested diagnostic pathways in malignant pleural disease, to outline management options for malignant pleural effusion and malignant pleural mesothelioma, highlighting the need for a holistic approach, and to discuss potential challenges including non-expandable lung and septated effusions.

Copyright ©ERS 2024.

In plain English

This article was a narrative review by authors based at hospitals in Dublin, Ireland, on malignant pleural disease. That term covers cancer in the lining of the lung, including cancer-caused fluid build-up (malignant pleural effusion) and malignant pleural mesothelioma. It reported no new data. It summarized other studies on how common the disease is, how it develops, and how it is diagnosed and treated. Citing other sources, the review stated that malignant pleural effusion affects an estimated 1 million people a year worldwide. It reported that the WHO predicts an exponential rise in mesothelioma in developing countries where asbestos use is not strictly regulated, and that about 2700 new mesothelioma cases are diagnosed in the UK each year. It noted that pleural plaques on chest X-ray indicate prior asbestos exposure. For mesothelioma, cited studies reported fluid-test (cytology) sensitivity as low as 6%, lower pleurodesis success (73% versus 85%) and more frequent catheter tract metastases. The authors concluded that care should aim to ease symptoms, protect quality of life and reduce hospital days, and that surgery alone cannot be recommended for mesothelioma.

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: Narrative review of published literature (no new data collected)
• Who was studied: No study population of its own. The review covered published research on patients with malignant pleural disease, including malignant pleural effusion and malignant pleural mesothelioma.
• Exposure: Asbestos was mentioned only in passing: in relation to rising mesothelioma where asbestos use is not strictly regulated, and pleural plaques on chest X-ray as a sign of prior asbestos exposure. No fiber types or doses were discussed.
• Main results:
  • Citing other sources, the review stated that malignant pleural effusion affects an estimated 1 million people worldwide per year.
  • Citing other sources, the review stated that malignant pleural effusion is incurable, with a median survival of 3 to 12 months.
  • Citing other sources, the review reported that the WHO predicts an exponential rise in malignant pleural mesothelioma in developing countries where asbestos use is not strictly regulated.
  • Citing other sources, the review stated that an estimated 2700 new mesothelioma cases are diagnosed in the UK each year, with peak incidence at ages 85 to 89. It also said the reduction in UK incidence despite asbestos regulations has been only 7%.
  • Citing other sources, the review stated that an effusion is present at diagnosis in more than 90% of malignant pleural mesothelioma cases.
  • Citing other sources, the review stated that pleural fluid cytology sensitivity for mesothelioma has been reported as low as 6%, though recent advances have improved this.
  • Citing a cited analysis, the review stated that pleurodesis success was significantly lower in patients with malignant pleural mesothelioma (73% versus 85%, p=0.002).
  • The review's complications table, citing other studies, gave catheter tract metastasis after indwelling pleural catheters as 14 to 42% in mesothelioma and 0.4 to 4.6% in other cancers.
  • Citing other sources, the review reported that cisplatin plus pemetrexed increased median overall survival in mesothelioma by 2.8 months compared with cisplatin alone. It also said that nivolumab plus ipilimumab (CheckMate 743) improved response rates and overall survival compared with chemotherapy.
  • Citing other sources, the review stated that neither extrapleural pneumonectomy nor pleurectomy/decortication has shown a survival benefit for mesothelioma in a prospective randomized trial. It said morbidity and mortality rates reached as high as 31% for extrapleural pneumonectomy.
• The authors' conclusion: The authors concluded that minimizing symptoms, optimizing quality of life and reducing hospital days are key to personalized management. They also concluded that surgery as a standalone treatment cannot be recommended in malignant pleural mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Life Expectancy, Quality of Life, Epidemiology, Pleural Mesothelioma.

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