Mestohelioma articles- Review Studies-

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A systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for diffuse malignancy peritoneal mesothelioma.

Ann Oncol. 2006 Nov 27; [Epub ahead of print]
Yan TD, Welch L, Black D, Sugarbaker PH.
Program in Peritoneal Surface Oncology, Washington Cancer Institute, Washington Hospital Center, Washington, DC.

BACKGROUND: In the past, diffuse malignant peritoneal mesothelioma (DMPM) was regarded as a preterminal condition. The length of survival was dependent upon the aggressive versus indolent biologic behavior of the neoplasm. The overall median survival was approximately 1 year after systemic chemotherapy. Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has been used as a treatment alternative, but the efficacy of this combined treatment remains to be established. PATIENTS AND METHODS: Searches for relevant studies published in peer-reviewed medical journals on CRS and PIC for DMPM before May 2006 were carried out on six databases. The reference lists of all retrieved articles were reviewed for further identification of potentially relevant studies. Expert academic surgeons in Washington, DC, USA were asked whether they knew about any important unpublished data. Two investigators independently evaluated each study according to predefined criteria. The quality of each study was assessed. Clinical effectiveness was synthesized through a narrative review with full tabulation of results of all included studies. RESULTS: Seven prospective observational studies from six tertiary institutions were available, allowing 240 DMPM patients for assessment. The median survival ranged from 34-92 months. The 1-, 3- and 5-year survival varied from 60% to 88%, 43% to 65% and 29% to 59%, respectively. The perioperative morbidity varied from 25% to 40% and mortality ranged from 0% to 8%. CONCLUSIONS: This systematic review evaluated the current evidence for CRS and PIC for DMPM. Seven observational studies were available for assessment, which demonstrated an improved overall survival, as compared to historical controls, using systemic chemotherapy and palliative surgery.

PMID: 17130182 [PubMed - as supplied by publisher]


Malignant pleural mesothelioma: a comprehensive review.

Cancer Control. 2006 Oct;13(4):255-63.
Ismail-Khan R, Robinson LA, Williams CC Jr, Garrett CR, Bepler G, Simon GR.
Thoracic Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.

BACKGROUND: The incidence of malignant mesothelioma continues to increase, but the disease remains difficult to detect early and treat effectively. METHODS: The authors review the pathogenesis, incidence, clinical presentation, diagnosis, pathology, and both standard and experimental treatments for mesothelioma. RESULTS: When possible, surgery (video-assisted thoracoscopy, pleurectomy/decortication, or extrapleural pneumonectomy) is utilized. Effects on underlying structures limit application of radiation therapy, but some systemic agents are beginning to enhance survival. CONCLUSIONS: The disease is expected to increase in incidence till 2020, so awareness of this entity as a possible diagnosis should be heightened. In patients with advanced disease, several newer antitumor agents are already showing a capability of extending survival so it is not unreasonable to expect further progress in this area.

Pathology of human malignant mesothelioma--preliminary analysis of 1,517 mesothelioma cases.

Ind Health 2001 Apr;39(2):183-5
Suzuki Y.
Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, New York, 10029, USA.

The author reviewed 1,517 human malignant mesothelioma cases from 1975 through August 2000. These mesothelioma cases were definite or probable in diagnostic certainty. Sources of these cases varied including asbestos insulation workers, UNARCO workers, Cancer and Leukemia B mesothelioma panel cases and random cases. Pathology materials consisted of autopsy, biopsy and rare cytology specimens. 92.3% of these patients were male, and 85.8% were between 50 and 79 years in age. The major primary site of the tumor was the pleura (73.1%). However, in a group of the asbestos insulation workers, the peritoneum was the more common primary site of malignant mesothelioma, compared to the pleura. Histologically, epithelial cell type was the majority (61.1%), followed by biphasic (22.1%) and fibrosarcomatous (16.4%). A double primary tumor (malignant mesothelioma associated with other cancer) was present in 32 of the 1,517 cases. These 32 cancers included lung cancers, renal cell carcinomas, colorectal cancers, pancreatic cancers and a cancer of the larynx, which are known to be at higher risk among asbestos insulation workers. The latency period of the vast majority (98.1%) of these mesothelioma cases were longer than 20 years. It is well accepted that cigarette smoking does not contribute to the induction of malignant mesothelioma. Indeed, the present study confirmed that 19.9% of these mesothelioma patients had never smoked cigarettes.

Treatment of malignant mesothelioma.

World J Surg 2001 Feb;25(2):210-7
Jaklitsch MT, Grondin SC, Sugarbaker DJ.
Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA.

Malignant pleural mesothelioma (MPM) is a rare tumor that predominantly afflicts men over 50 years of age. Nearly 3000 MPMs are reported annually in the United States with the incidence expected to rise into the new millenium. Over the past 40 years, MPM has been unequivocally linked to asbestos exposure worldwide. Recently, however, a new theory on the carcinogenesis of this tumor has been proposed with the isolation of a simian virus (SV 40)-like gene sequence in mesothelioma tumor cells. The clinical presentation of MPM is variable, although most patients typically present with dyspnea, chest pain, or pleural effusion. Obtaining a diagnosis of MPM has been greatly assisted by video-assisted surgery and the use of immunohistochemistry and electron microscopic techniques, which help distinguish MPM from other tumor pathologies such as adenocarcinoma. Computed tomography and magnetic resonance imaging have been also useful for determining tumor burden and resectability. Traditionally, strategies for the treatment of MPM have included supportive care, surgery, radiotherapy, and chemotherapy. Survival with supportive care alone ranges between 4 and 12 months. Single-modality therapy using traditional approaches (surgery, radiotherapy, chemotherapy) alone has failed to improve patient survival significantly. Recently, results using a multimodality approach have been favorable. In particular, cytoreductive surgery (pleuropneumonectomy) followed by sequential chemotherapy and radiotherapy have demonstrated improved survival, especially for patients with epithelial histology, negative resection margins, and no metastases to extrapleural lymph nodes. Innovative therapies such as the use of photodynamic, targeted cytokines and gene therapy are currently being investigated for management of MPM.

Advances in the treatment of malignant pleural mesothelioma

Chest 1999 Aug;116(2):504-20
Sterman DH, Kaiser LR, Albelda SM
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania Medical Center, Philadelphia 19104, USA. [email protected]

Malignant pleural mesothelioma is a neoplasm that is commonly fatal and for which there are no widely accepted curative approaches. Mesothelioma is unresponsive to most chemotherapy and radiotherapy regimens, and it typically recurs even after the most aggressive attempts at surgical resection. Multimodality approaches have been of some benefit in prolonging survival of very highly selected subgroups of patients, but they have had a relatively small impact on the majority of the patients diagnosed with this disease. As the incidence of pleural mesothelioma peaks in the United States and Europe over the next 10 to 20 years, new therapeutic measures will be necessary. This review will discuss the roles of chemotherapy, radiotherapy, surgery, and combined modality approaches in the treatment of pleural mesothelioma, as well as scientific advances made in the past decade that have led to the development of experimental techniques, such as photodynamic therapy, immunotherapy, and gene therapy, that are currently undergoing human clinical trials. These promising new avenues may modify the therapeutic nihilism that is rampant among clinicians dealing with mesothelioma.

Current Therapy For Mesothelioma

Brigham and Women's Hospital, Boston, MA
Division of Thoracic Surgery
David J. Sugarbaker, MD, Jose J. Norberto, MD,
and Raphael Bueno, MD

Malignant pleural mesothelioma is locally aggressive, invasive, and almost universally fatal.
INTRODUCTION

Mesotheliomas of the pleural cavity are relatively rare tumors. Generally, two types of pleural tumors can be referred to as mesotheliomas. The less common is the solitary (or localized) fibrous tumor of the pleura, previously known as "benign mesothelioma." This slow-growing, commonly benign, well- circumscribed tumor is pedunculated on a pleural-based pedicle and often is cured by resection. The tumor appears to originate from submesothelial rather than mesothelial or epithelial cells. The more common variety is the diffuse malignant pleural mesothelioma (DMPM), a true mesothelial malignancy that is locally aggressive, invasive, and almost universally fatal. This multicentric tumor infiltrates the pleural space, results in a pleural effusion, and mechanically compresses the surrounding structures. Though distant metastatic lesions may be seen in up to 30% of cases in autopsy series, most patients die of locoregional invasion and compression of vital structures. The median survival for patients with DMPM is between four and 12 months, depending on the stage at presentation.

BACKGROUND*: Diffuse malignant pleural mesotheliomas (DMPMs) are highly lethal tumors that are becoming more common. Standard management approaches have provided limited effectiveness.

METHODS*: The literature on management has been revised, and the authors present their data on outcomes for 120 patients treated with an aggressive trimodality approach.

RESULTS*: An aggressive trimodality approach including extrapleural pneumonectomy followed by chemoradiation produces low mortality and acceptable morbidity. The five-year survival rate in patients with epithelial histology and negative nodes approaches 40%.

CONCLUSIONS: Mesothelioma is increasing in frequency and presents many diagnostic and management challenges. An optimal universal staging system is still awaiting definition and validation. Prognosis is best for patients with localized disease and epithelial histology. Surgical techniques including pleurectomy/decortication and EPP can result in a major debulking of disease, and studies are ongoing to determine if the addition of chemotherapy and radiation has an impact on survival. Several new investigational approaches are now being tested, including intrapleural interferon gamma, photodynamic therapy, immunotherapy, and gene therapy.

*For the full text of this study, please see the July/August 1997 online issue of Cancer Control, Journal of the Moffitt Cancer Center.

From Dr. Lary A. Robinson, M.D.

Director, Division of Cardiovascular and Thoracic Surgery
USF Physicians Group
University of South Florida College of Medicine

Dear Mr. Early,

Thank you for your letter of May 19, 1998 inquiring about our mesothelioma treatment program. At the H. Lee Moffitt Cancer Center and Research Institute, we have a strong interest and experience in the evaluation and treatment of malignant pleural mesothelioma of all stages.

Our thoracic oncology group evaluates patients with a multidisciplinary approach involving medical oncologists, pulmonologists, radiation oncologists, thoracic pathologists, thoracic radiologists, and thoracic surgeons. For the earlier stage I and II mesothelioma in patients with no prior therapy and in good condition, we favor an aggressive approach with surgery (extrapleural pneumonectomy) followed by adjuvant chemotherapy local radiation therapy. For more advanced mesotheliomas or non-surgical candidates, we treat most patients with a chemotherapy protocol, possibly with adjuvant measures for palliation such a thoracoscopic talc poudrage. We are in the developmental stages of a systemic gene therapy program but this is not into clinical trials yet. The thoracic medical oncologists involved with our mesothelioma patients include Drs. Jack Ruckdeschel, Linda Garland, Scott Antonia, Charles Williams, and Gail Shaw. Our thoracic radiation oncologist is Dr. Henry Wagner. As a thoracic surgical oncologist, my own expertise lies with the surgical treatment of this disease, but I maintain a strong interaction with the medical members of our mesothelioma team.

Here at the Moffitt Cancer Center, we have a strong interest in mesothelioma and any of us would be happy to see new patients or to consult by telephone and provide assistance in any way possible. Again, many thanks for your inquiry. If I can be of any future assistance, please feel free to call upon me or other members of the thoracic oncology program.

Sincerely,

Lary A. Robinson, M.D.
Director, Division of Cardiovascular and Thoracic Surgery
 
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