Spare the lung: surgical treatment approach for malignant pleural mesothelioma

Our plain-English summary of Spare the lung: surgical treatment approach for malignant pleural mesothelioma, by N. Fujimoto (Translational Lung Cancer Research, 2023).

The study

• Author: N. Fujimoto
• Journal: Translational Lung Cancer Research
• Published: 2023;12(2):197-199
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher · Free full text

In plain English

This is an editorial, not a new study. The author commented on a retrospective study by Klotz and colleagues of patients with epithelioid malignant pleural mesothelioma (MPM) treated at a single high-volume center in Germany. The author noted that MPM is strongly associated with past asbestos exposure. The Klotz study compared three groups. One had extrapleural pneumonectomy (EPP). One had a less radical, lung-sparing extended pleurectomy/decortication (EPD) combined with hyperthermic intrathoracic chemoperfusion (HITOC) and chemotherapy afterward. One had chemotherapy alone. As reported in the editorial, median overall survival was 38.1 months in the EPD/HITOC group, 24.0 months in the EPP group and 15.8 months in the chemotherapy group, whose patients had unresectable, advanced disease. Complications around surgery were more frequent after EPP (36.2%) than after EPD/HITOC (18%). The author wrote that these real-world data might support lung-sparing surgery as the first choice. The author also listed limitations: the retrospective design, the limited number of patients, differences between the groups, and treatment improvements over time. The author called for prospective trials. The editorial did not undergo external peer review.

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 (commissioned commentary) on another group's published retrospective study; it reports no new data of its own
• Who was studied: No population of its own. The editorial discusses the Klotz study of patients with epithelioid MPM treated with a multimodal approach over the last two decades at a single high-volume center in Germany. The editorial does not give total patient numbers.
• Exposure: No asbestos exposure was studied. The treatments compared in the Klotz study were EPP; extended pleurectomy/decortication with hyperthermic intrathoracic chemoperfusion and adjuvant chemotherapy (EPD/HITOC); and chemotherapy alone. Asbestos is mentioned only as background: the author states MPM is strongly associated with past asbestos exposure.
• Main results:
  • In the Klotz study (as reported in the editorial), median overall survival was 38.1 months in the EPD/HITOC cohort, 24.0 months in the EPP cohort and 15.8 months in the chemotherapy cohort.
  • In the Klotz study's multivariate analysis, EPD/HITOC was significantly associated with improved overall survival.
  • In the Klotz study, better survival was significantly associated with good performance status, younger age and negative lymph node status.
  • In the Klotz study, the perioperative morbidity rate was significantly higher in the EPP cohort (36.2%) than in the EPD/HITOC cohort (18%).
  • The editorial's author considered it expected that survival was worst in the chemotherapy cohort, because those patients had unresectable, advanced disease.
• The authors' conclusion: The editorial's author wrote that the Klotz real-world data might support a less radical lung-sparing technique as the first-choice surgery for epithelioid MPM. The author also wrote that many problems remain and hoped that prospective clinical trials and real-world data would establish an optimal approach.
• Limitations the authors state:
  • The editorial's author named the Klotz study's main limitations as its retrospective design and the limited number of selected patients.
  • The EPD/HITOC cohort had more patients and better performance status than the EPP cohort.
  • Because the two surgical approaches were used in different time periods, improvements in perioperative care and in treating recurrence may have contributed to the better survival in the EPD/HITOC cohort.
  • The role of HITOC has not been established, and its efficacy has not been shown in a prospective trial.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma.

Related studies

• Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach — L.V. Klotz, H. Hoffmann, et al. (2022)
• Surgical approach to pleural diffuse mesothelioma in Japan — K. Takagi, R. Tsuchiya, et al. (2001)
• A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma — C. Cao, D. Tian, et al. (2014)
• Solitary fibrous tumors of the pleura: clinical characteristics, surgical treatment and outcome — P. Magdeleinat, M. Alifano, et al. (2002)
• The importance of surgical staging in the treatment of malignant pleural mesothelioma — V.W. Rusch, E. Venkatraman (1996)
• 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 — V. Rusch, E.H. Baldini, et al. (2013)

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