Review question

Does radical surgery with or without radiotherapy improve the length and health-related quality of life in people with localised malignant mesothelioma, compared with chemotherapy and supportive care only?

Background

Malignant pleural mesothelioma (that is, primary pleural cancer) is a difficult tumour to treat. Chemotherapy is usually given first to people who are fit enough to have it. It is not clear whether radical surgery and radiotherapy help people to live longer or improve their overall health-related quality of life.

Study characteristics

We searched published medical articles to find research papers that looked at combined treatment strategies with surgery for treating people with primary pleural cancer. We looked for randomised clinical trials (where people were allocated at random to one of two or more treatments groups) and used information from those we found to form our conclusions. We found evidence up to 21 March 2017.

Key results

The review authors found two small randomised clinical trials, in which a total of 104 people with pleural mesothelioma were randomised. One trial compared the addition of surgery and radiotherapy to chemotherapy with chemotherapy alone. The other trial compared the addition of radiotherapy to chemotherapy and surgery with chemotherapy and surgery alone. These two small trials suggested that there is no added value for either radiotherapy or combined radiotherapy and surgery. We could not combine the data from the trials as we had intended, because the two trials were too different. We rated the quality of evidence as moderate for survival and low quality for all the other outcomes studied. The review authors identified three ongoing randomised clinical trials, the results of which have not been published yet.

Quality of evidence and conclusions

We only found two relevant trials. Both were small, which made the results uncertain. It is not clear whether giving a combination of surgery and radical radiotherapy after chemotherapy is better than giving chemotherapy alone. Radical radiotherapy does not seem to improve the results of surgery alone.