Therapeutic Openings In The Treatment Of Mesothelioma

Our plain-English summary of Therapeutic Openings In The Treatment Of Mesothelioma, by P.C. Elmes (1973).

The study

• Author: P.C. Elmes
• Published: Biological Effects Of Asbestos (J.C. Wagner, Editor), Lyon: Iarc Scientific Publications, Volume 8, Pp. 277-280 (1973)
• Type of article: Conference paper
• Our copy: from Johns-Manville's own medical library, J-M no. 002387. The article is still under copyright, so we describe it here rather than post it.

In plain English

This paper by P.C. Elmes was a review of how mesothelioma was being diagnosed and treated. It drew on the Northern Ireland and Great Britain patient groups described in the author's preceding paper, and on published reports. The author noted that no published study had compared treatments in matched patients followed forward in time. In the Northern Ireland series, mean survival from referral was 8.4 months for 26 patients who had minimal diagnostic tests, 11.4 months for 8 who had needle biopsy only, and 10.8 months for 27 who had open biopsy or attempted excision. These differences were not statistically significant, and the author attributed the pattern to how patients were selected. Survival also did not differ significantly across four treatment groups. Tumour growth into surgical scars and along needle tracks was seen. As far as the author could determine, blood-borne spread occurred only in treated patients. The author concluded that the best management was relieving symptoms with as few diagnostic procedures as possible, and that radiation, radical surgery and systemic cytotoxic drugs may be actively harmful.

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 of diagnostic and treatment methods for mesothelioma, combining published reports with a retrospective look at the author's own Northern Ireland and Great Britain case series
• Who was studied: Patients with mesothelioma of the pleura or peritoneum in the Northern Ireland series and in a Great Britain series, the same groups described in the author's preceding paper. The Northern Ireland diagnostic table lists groups of 26, 8 and 27 cases (61 when added together), and the treatment table lists groups of 23, 23, 11 and 5 cases (62 when added together). Dates and places are not given in this paper.
• Exposure: Not an asbestos exposure study. What was compared were diagnostic procedures (tapping of fluid, needle biopsy, open biopsy or attempted excision) and treatments (no treatment, tapping only, local cytotoxic agents or local radiotherapy, general cytotoxic therapy, surgical excision)
• Main results:
  • Northern Ireland series, by diagnostic measure: mean survival from first hospital visit was 8.4 months with minimal diagnostic effort (26 cases), 11.4 months with needle biopsy only (8 cases) and 10.8 months with open biopsy or attempted excision (27 cases). The differences were not statistically significant.
  • The author explained that very advanced cases could have neither needle biopsy nor surgery, so they were concentrated in the minimal-diagnosis group.
  • Northern Ireland series: open biopsy or attempted excision carried a risk of tumour seeding in the scar and involving the skin. Extension along the needle track was frequent after needle biopsy but relatively uncommon after simple tapping.
  • Northern Ireland series, by treatment: there was no significant difference in survival between the four groups (no treatment, 23 cases; tapping only, 23; local cytotoxic agent or local radiotherapy, 11; general cytotoxic therapy, 5).
  • Skin involvement by tumour was seen only through a wound, a needle puncture or skin that had been irradiated.
  • Local cytotoxic or radioactive therapy seldom did more than reduce fluid tapping from once a week to once every two weeks. General cytotoxic therapy, used in five cases, did not halt tumour progress or relieve pain.
  • Among the Northern Ireland, Great Britain and reported cases, blood-borne metastases (to the brain, pituitary, adrenals and elsewhere) had, as far as the author could determine, occurred only in patients who had surgery, radiation or cytotoxic therapy.
  • Local cytotoxic treatment was frequently used in the Northern Ireland and Great Britain series, with no report of a cure.
• The authors' conclusion: The author concluded that the best management of pleural and peritoneal mesothelioma was symptomatic, with diagnostic measures kept to a minimum. Putting cytotoxic agents or talc into the pleural cavity was probably of no value, and radiation, radical surgery and systemic cytotoxic drug therapy may be actively harmful. The author suggested that future early diagnosis and treatment would depend on understanding the tumour's immunology.
• Limitations the authors state:
  • No published study had compared treatments in matched groups of patients prospectively, and retrospective studies are no substitute.
  • The way the Northern Ireland cases were selected for each treatment prevents judging whether any treatment prolonged life.
  • Tumour spread along tracks became more frequent the longer patients survived, so its frequency could not be compared across the three diagnostic procedures.
  • Whether systemic therapy spreads the tumour could not be judged, because too many of the cases analysed had received several therapies.

Topics

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

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