Radical multimodality therapy for malignant pleural mesothelioma.


BACKGROUND:Malignant pleural mesothelioma is an almost always fatal tumour, for which palliative platinum-based chemotherapy is currently the standard treatment. Multimodal therapeutic strategies incorporating surgery, radiation therapy or photodynamic therapy and chemotherapy have been recommended for selected patients but there is no consensus about their effectiveness. OBJECTIVES:To assess the benefits and harms of radical multimodal treatment options (including radical surgery ± radical radiotherapy ± photodynamic therapy ± systemic therapy) compared to each other or to palliative treatments, for people with malignant pleural mesothelioma. SEARCH METHODS:We reviewed data from the Cochrane Lung Cancer group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase. We also checked reference lists of primary original studies, review articles and relevant conference proceedings manually for further related articles up to 21 March 2017. SELECTION CRITERIA:We included parallel-group randomised controlled trials of multimodal therapy for people with malignant pleural mesothelioma (stages I, II or III) that measured at least one of the following endpoints: overall survival, health-related health-related quality of life, adverse events or progression-free survival. We considered studies regardless of language or publication status. DATA COLLECTION AND ANALYSIS:Two review authors independently extracted relevant information on participant characteristics, interventions, study outcomes, and data on the outcomes for this review, as well as information on the design and methodology of the studies. Two review authors assessed the risk of bias in the included trials using pre-defined 'Risk of bias' domains. We assessed the methodological quality using GRADE. MAIN RESULTS:We conducted this review in accordance with the published Cochrane protocol. Two randomised clinical trials with 104 participants fulfilled our inclusion criteria. Both trials were at high risk of bias (for outcomes other than overall survival), and we rated the evidence as moderate quality for overall survival and low quality for all other outcomes. One trial compared combined extrapleural pneumonectomy (EPP) plus neoadjuvant platinum-based chemotherapy plus postoperative high-dose hemithoracic radiotherapy with combined EPP plus platinum-based chemotherapy. The other trial compared EPP plus postoperative hemithoracic radiotherapy with standard (non-radical) therapy alone following platinum-based chemotherapy (patients in the standard therapy arm received continued oncological management according to local policy, which could include further chemotherapy or palliative radiotherapy).For the first trial, median overall survival calculated from registration was 20.8 months (95% confidence interval (CI) 14.4 to 27.8) in the no-radiotherapy group and 19.3 months (95% CI 11.5 to 21.8) in the radiotherapy group. For the second trial, median overall survival was 14.4 months (95% CI 5.3 to 18.7) for patients allocated to EPP and 19.5 months (95% CI 13.4 to time not yet reached) for patients randomised to standard non-radical therapy. In the second trial, 12 serious adverse events were reported during the study period: ten in the EPP group and two in the non-radical therapy group. Overall health-related quality of life scores were not different between the two arms in either study. We could not perform a meta-analysis of the two included trials due to clinical heterogeneity. We also identified three ongoing trials evaluating the topic of our review. AUTHORS' CONCLUSIONS:The overall strength of the evidence gathered in this review is low and there is a lack of available evidence to support the use of radical multimodality therapy in routine clinical practice (particularly as one trial suggests greater harm). Given the added cost of multimodality treatment and the possible increase in risk of adverse effects, the lack of evidence of their effectiveness probably means that these interventions should currently be limited to clinical trials alone.


Abdel-Rahman O,Elsayed Z,Mohamed H,Eltobgy M




Has Abstract


2018-01-08 00:00:00








  • Low bacterial diet versus control diet to prevent infection in cancer patients treated with chemotherapy causing episodes of neutropenia.

    abstract:BACKGROUND:Neutropenia is a potentially serious side effect of chemotherapy and a major risk factor for infection, which can be life-threatening. It has been hypothesised that a low bacterial diet (LBD) can prevent infection and (infection-related) mortality in cancer patients receiving chemotherapy that causes episode...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: van Dalen EC,Mank A,Leclercq E,Mulder RL,Davies M,Kersten MJ,van de Wetering MD

    更新日期:2016-04-24 00:00:00

  • Fluticasone versus HFA-beclomethasone dipropionate for chronic asthma in adults and children.

    abstract:BACKGROUND:The relative efficacy of fluticasone (FP) and beclomethasone (BDP) propelled with CFCs has been well established. The potency of HFA-BDP is thought to have been improved with new propellant and some studies suggest that it may equipotent at half the dose of CFC propelled-BDP. There is a need to revisit this ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Lasserson TJ,Cates CJ,Jones AB,Steele EH,White J

    更新日期:2005-10-19 00:00:00

  • Antibiotics for the common cold and acute purulent rhinitis.

    abstract:BACKGROUND:It has long been believed that antibiotics have no role in treating common colds yet they are often prescribed in the belief that they may prevent secondary bacterial infections. Given the increasing concerns about antibiotic resistance it is important to examine the evidence for the benefit of antibiotics f...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Arroll B,Kenealy T

    更新日期:2005-07-20 00:00:00

  • Vaccines for preventing rotavirus diarrhoea: vaccines in use.

    abstract:BACKGROUND:Rotavirus results in more diarrhoea-related deaths in children less than five years of age than any other single agent in countries with high childhood mortality. It is also a common cause of diarrhoea-related hospital admissions in countries with low childhood mortality. Currently licensed rotavirus vaccine...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Soares-Weiser K,Maclehose H,Bergman H,Ben-Aharon I,Nagpal S,Goldberg E,Pitan F,Cunliffe N

    更新日期:2012-11-14 00:00:00

  • Methadone at tapered doses for the management of opioid withdrawal.

    abstract:BACKGROUND:Despite use in many countries of tapered methadone for detoxification from opiate, the evidence of efficacy to prevent relapse and promote lifestyle change has not been systematically evaluated. OBJECTIVES:To determine whether tapered methadone is effective to manage withdrawal from opioids. SEARCH STRATEG...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Amato L,Davoli M,Ferri M,Ali R

    更新日期:2002-01-01 00:00:00

  • Nicotine replacement therapy for smoking cessation.

    abstract:BACKGROUND:The aim of nicotine replacement therapy (NRT) is to temporarily replace much of the nicotine from cigarettes to reduce motivation to smoke and nicotine withdrawal symptoms, thus easing the transition from cigarette smoking to complete abstinence. OBJECTIVES:The aims of this review were: To determine the eff...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Stead LF,Perera R,Bullen C,Mant D,Hartmann-Boyce J,Cahill K,Lancaster T

    更新日期:2012-11-14 00:00:00

  • High dose rate versus low dose rate intracavity brachytherapy for locally advanced uterine cervix cancer.

    abstract:BACKGROUND:This is an updated version of the original Cochrane review published in 2010 (Issue 7).Carcinoma of the uterine cervix is the second most common cancer and the third leading cause of cancer death among women. Radiotherapy has been used successfully to treat cervical cancer for nearly a century. The combinati...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Liu R,Wang X,Tian JH,Yang K,Wang J,Jiang L,Hao XY

    更新日期:2014-10-09 00:00:00

  • Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery.

    abstract:BACKGROUND:Preterm birth is birth before 37 weeks' gestation. Genital tract infection is one of the causes of preterm birth. Infection screening during pregnancy has been used to reduce preterm birth. However, infection screening may have some adverse effects, e.g. increased antibiotic drug resistance, increased costs ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Swadpanich U,Lumbiganon P,Prasertcharoensook W,Laopaiboon M

    更新日期:2008-04-16 00:00:00

  • Fetal electrocardiogram (ECG) for fetal monitoring during labour.

    abstract:BACKGROUND:Hypoxaemia during labour can alter the shape of the fetal electrocardiogram (ECG) waveform, notably the relation of the PR to RR intervals, and elevation or depression of the ST segment. Technical systems have therefore been developed to monitor the fetal ECG during labour as an adjunct to continuous electro...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Neilson JP

    更新日期:2006-07-19 00:00:00

  • Ready-to-use therapeutic food (RUTF) for home-based nutritional rehabilitation of severe acute malnutrition in children from six months to five years of age.

    abstract:BACKGROUND:Management of severe acute malnutrition (SAM) in children comprises two potential phases: stabilisation and rehabilitation. During the initial stabilisation phase, children receive treatment for dehydration, electrolyte imbalances, intercurrent infections and other complications. In the rehabilitation phase ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章


    authors: Schoonees A,Lombard MJ,Musekiwa A,Nel E,Volmink J

    更新日期:2019-05-15 00:00:00

  • Antipsychotic medications for cocaine dependence.

    abstract:BACKGROUND:Cocaine dependence is a public health problem characterized by recidivism and a host of medical and psychosocial complications. Cocaine dependence remains a disorder for which no pharmacological treatment of proven efficacy exists, although considerable advances in the neurobiology of this addiction could gu...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Amato L,Minozzi S,Pani PP,Davoli M

    更新日期:2007-07-18 00:00:00

  • Antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks.

    abstract:BACKGROUND:Non-valvular atrial fibrillation (AF) carries an increased risk of stroke. Antiplatelet therapy (APT) is proven effective for stroke prevention in most patients at high-risk for vascular events, but its value for primary stroke prevention in patients with non-valvular AF merits separate consideration because...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Aguilar M,Hart R

    更新日期:2005-10-19 00:00:00

  • Rapid diagnostic tests for plague.

    abstract:BACKGROUND:Plague is a severe disease associated with high mortality. Late diagnosis leads to advance stage of the disease with worse outcomes and higher risk of spread of the disease. A rapid diagnostic test (RDT) could help in establishing a prompt diagnosis of plague. This would improve patient care and help appropr...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章


    authors: Jullien S,Dissanayake HA,Chaplin M

    更新日期:2020-06-26 00:00:00

  • Pericyazine for schizophrenia.

    abstract:BACKGROUND:Pericyazine is a 3-cyano-10 (3-4'-hydroxypiperidinopropyl) phenothiazine. It is overall pharmacologically similar with chlorpromazine, though particularly sedating. Dopamine receptor subtype analysis has not been performed for pericyazine, but the drug appears to induce greater noradrenergic than dopaminergi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Matar HE,Almerie MQ,Makhoul S,Xia J,Humphreys P

    更新日期:2014-05-13 00:00:00

  • Absorbable versus non-absorbable sutures for skin closure after carpal tunnel decompression surgery.

    abstract:BACKGROUND:Carpal tunnel syndrome is a common problem and surgical decompression of the carpal tunnel is the most effective treatment. After surgical decompression, the palmar skin may be closed using either absorbable or non-absorbable sutures. To date, there is conflicting evidence regarding the ideal suture material...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Wade RG,Wormald JC,Figus A

    更新日期:2018-02-01 00:00:00

  • Local cooling for relieving pain from perineal trauma sustained during childbirth.

    abstract:BACKGROUND:Perineal trauma is common during childbirth and may be painful. Contemporary maternity practice includes offering women numerous forms of pain relief, including the local application of cooling treatments. OBJECTIVES:To evaluate the effectiveness and side effects of localised cooling treatments compared wit...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: East CE,Begg L,Henshall NE,Marchant PR,Wallace K

    更新日期:2012-05-16 00:00:00

  • Aromatase inhibitors for subfertile women with polycystic ovary syndrome.

    abstract:BACKGROUND:Polycystic ovary syndrome (PCOS) is the most common cause of infrequent periods (oligomenorrhoea) and absence of periods (amenorrhoea). It affects about 4% to 8% of women worldwide and often leads to anovulatory subfertility. Aromatase inhibitors (AIs) are a novel class of drugs that were introduced for ovul...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Franik S,Kremer JA,Nelen WL,Farquhar C

    更新日期:2014-02-24 00:00:00

  • Interventions for improving the psychosocial well-being of children affected by HIV and AIDS.

    abstract:BACKGROUND:As a result of HIV-related mortalities more than 13 million children under the age of 15 have lost a parent due to HIV and AIDS. There are also many children who have HIV-positive parents or primary caregivers; these children are affected by HIV and AIDS and are potentially vulnerable to HIV transmission. Ch...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: King E,De Silva M,Stein A,Patel V

    更新日期:2009-04-15 00:00:00

  • Oral calorie supplements for cystic fibrosis.

    abstract:BACKGROUND:Poor nutrition occurs frequently in people with cystic fibrosis (CF) and is associated with other adverse outcomes. Oral calorie supplements are used to increase total daily calorie intake and improve weight gain. However, they are expensive and there are concerns they may reduce the amount of food eaten and...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Smyth R,Walters S

    更新日期:2007-01-24 00:00:00

  • Prophylactic corticosteroids for preterm birth.

    abstract:BACKGROUND:Respiratory distress syndrome is a serious complication of prematurity causing significant immediate and long-term mortality and morbidity. OBJECTIVES:The objective of this review was to assess the effects of corticosteroids administered to pregnant women to accelerate fetal lung maturity prior to preterm d...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Crowley P

    更新日期:2000-01-01 00:00:00

  • WITHDRAWN: Ribavirin with or without alpha interferon for chronic hepatitis C.

    abstract:BACKGROUND:Hepatitis C is a major cause of liver-related morbidity and mortality. Ribavirin plus interferon combination therapy is presently considered the optimal treatment of interferon naive patients with chronic hepatitis C, but its role in relapsers and non-responders to previous interferon therapy is not establis...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Gluud LL,Krogsgaard K,Gluud C

    更新日期:2007-07-18 00:00:00

  • Psychosocial interventions for preventing and treating depression in dialysis patients.

    abstract:BACKGROUND:People with end-stage kidney disease (ESKD) treated with dialysis are frequently affected by major depression. Dialysis patients have prioritised depression as a critically important clinical outcome in nephrology trials. Psychological and social support are potential treatments for depression, although a Co...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Natale P,Palmer SC,Ruospo M,Saglimbene VM,Rabindranath KS,Strippoli GF

    更新日期:2019-12-02 00:00:00

  • Corticosteroids for treating optic neuritis.

    abstract:BACKGROUND:Optic neuritis is an inflammatory disease of the optic nerve. It occurs more commonly in women than in men. Usually presenting with an abrupt loss of vision, recovery of vision is almost never complete. Closely linked in pathogenesis to multiple sclerosis, it may be the initial manifestation for this conditi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Gal RL,Vedula SS,Beck R

    更新日期:2012-04-18 00:00:00

  • Re-feeding versus discarding gastric residuals to improve growth in preterm infants.

    abstract:BACKGROUND:Routine monitoring of gastric residuals in preterm infants on gavage feeds is a common practice in many neonatal intensive care units and is used to guide the initiation and advancement of feeds. No guidelines or consensus is available on whether to re-feed or discard the aspirated gastric residuals. Althoug...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章


    authors: Abiramalatha T,Thanigainathan S,Balakrishnan U

    更新日期:2019-07-08 00:00:00

  • WITHDRAWN: Iodine supplementation for preventing iodine deficiency disorders in children.

    abstract:BACKGROUND:Iodine deficiency is the main cause of potentially preventable mental retardation in childhood, as well as causing goitre and hypothyroidism in people of all ages. It is still prevalent in large parts of the world. OBJECTIVES:To assess the effects of iodine supplementation overall, and of different forms an...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章


    authors: Angermayr L,Clar C

    更新日期:2018-11-29 00:00:00

  • Antispasmodics for labour.

    abstract:BACKGROUND:Prolonged labour can lead to increased maternal and neonatal mortality and morbidity due to increased risks of maternal exhaustion, postpartum haemorrhage and sepsis, fetal distress and asphyxia and requires early detection and appropriate clinical response. The risks for complications of prolonged labour ar...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Rohwer AC,Khondowe O,Young T

    更新日期:2013-06-05 00:00:00

  • Pharmacological interventions for spasticity following spinal cord injury.

    abstract:BACKGROUND:Spasticity is a major health problem for patients with a spinal cord injury (SCI) that limits patients' mobility and affects independence in activities of daily living and work. Spasticity may also cause pain, loss of range of motion, contractures, sleep disorders and impair ambulation in patients with an in...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Taricco M,Adone R,Pagliacci C,Telaro E

    更新日期:2000-01-01 00:00:00

  • Band ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis.

    abstract:BACKGROUND:Portal hypertension commonly accompanies advanced liver disease and often gives rise to life-threatening complications, including haemorrhage from oesophageal and gastrointestinal varices. Variceal haemorrhage commonly occurs in children with chronic liver disease or portal vein obstruction. Prevention is th...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章


    authors: Gana JC,Cifuentes LI,Gattini D,Villarroel Del Pino LA,Peña A,Torres-Robles R

    更新日期:2019-09-24 00:00:00

  • Computer and mobile technology interventions to promote medication adherence and disease management in people with thalassemia.

    abstract::This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To identify and assess the effects of computer and mobile technology interventions designed to facilitate medication adherence and disease management in individuals with thalassemia, including: evaluating the effects of using compu...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章


    authors: Badawy SM,Morrone K,Thompson A,Palermo TM

    更新日期:2017-12-01 00:00:00

  • Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates.

    abstract:BACKGROUND:Establishment of a secure airway is a critical part of neonatal resuscitation in the delivery room and the neonatal unit. Videolaryngoscopy has the potential to facilitate successful endotracheal intubation and decrease adverse consequences of delay in airway stabilization. Videolaryngoscopy may enhance visu...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Lingappan K,Arnold JL,Fernandes CJ,Pammi M

    更新日期:2018-06-04 00:00:00