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Journal of Thoracic Oncology : Official... Nov 2018Surgical intervention plays an important role in the diagnosis, staging, and treatment of malignant pleural mesothelioma (MPM) and can be applied with curative or... (Review)
Review
Surgical intervention plays an important role in the diagnosis, staging, and treatment of malignant pleural mesothelioma (MPM) and can be applied with curative or palliative intent. The overall aim of surgery should be, as in any oncologic surgery, the macroscopic complete resection (MCR) of the tumor. Most importantly, the majority of patients with the diagnosis of MPM should be appropriately staged and initially evaluated in a multidisciplinary setting, including medical oncology, radiation oncology, and surgery after histologic diagnosis. Surgical staging, including determination of the histologic subtype and lymph node status, as well as clinical staging with positron-emission tomography-computer tomography scan and determination of cardiopulmonary reserve are crucial. Herein, we summarize the role of surgical resection, specifically macroscopic complete resection, performed as extrapleural pneumonectomy or extended pleurectomy/decortication in multimodality treatment settings and advocate for optimal patient selection for one or the other procedure. In addition, the roles of surgery in diagnosis of MPM and in palliative care are discussed.
Topics: Humans; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Pleural Neoplasms; Survival Analysis
PubMed: 30121394
DOI: 10.1016/j.jtho.2018.08.001 -
European Respiratory Review : An... Mar 2021Pleural infection and malignancy are among the most common causes of pleural disease and form the mainstay of pleural practice. There has been significant research and...
Pleural infection and malignancy are among the most common causes of pleural disease and form the mainstay of pleural practice. There has been significant research and increase in scientific understanding in these areas in the past decade. With regard to pleural infection, the rising incidence remains worrying. An increased awareness allowing earlier diagnosis, earlier escalation of therapy and the use of validated risk stratification measures may improve outcomes. In pleural malignancy, research has enabled clinicians to streamline patient pathways with focus on reducing time to diagnosis, definitive management of malignant pleural effusion and achieving these with the minimum number of pleural interventions. Trials comparing treatment modalities of malignant pleural effusion continue to highlight the importance of patient choice in clinical decision-making. This article aims to summarise some of the most recent literature informing current practice in these two areas.
Topics: Humans; Pleural Diseases; Pleural Effusion, Malignant; Pleural Neoplasms; Thoracic Surgical Procedures
PubMed: 33650525
DOI: 10.1183/16000617.0002-2020 -
European Respiratory Review : An... Mar 2021Malignant pleural mesothelioma is an aggressive, incurable cancer that is usually caused by asbestos exposure several decades before symptoms arise. Despite widespread... (Review)
Review
Malignant pleural mesothelioma is an aggressive, incurable cancer that is usually caused by asbestos exposure several decades before symptoms arise. Despite widespread prohibition of asbestos production and supply, its incidence continues to increase. It is heterogeneous in its presentation and behaviour, and diagnosis can be notoriously difficult. Identification of actionable gene mutations has proven challenging and current treatment options are largely ineffective, with a median survival of 10-12 months.However, the past few years have witnessed major advances in our understanding of the biology and pathogenesis of mesothelioma. This has also revealed the limitations of existing diagnostic algorithms and identified new treatment targets.Recent clinical trials have re-examined the role of surgery, provided new options for the management of associated pleural effusions and heralded the addition of targeted therapies. The increasing complexity of mesothelioma management, along with a desperate need for further research, means that a multidisciplinary team framework is essential for the delivery of contemporary mesothelioma care.This review provides a synthesised overview of the current state of knowledge and an update on the latest research in the field.
Topics: Asbestos; Biology; Humans; Mesothelioma; Mesothelioma, Malignant; Pleural Neoplasms
PubMed: 33472960
DOI: 10.1183/16000617.0226-2020 -
Thoracic Cancer Sep 2023Malignant pleural mesothelioma (MPM) is a malignant tumor originating from the pleura, and its incidence has been increasing in recent years. Due to the insidious onset...
Malignant pleural mesothelioma (MPM) is a malignant tumor originating from the pleura, and its incidence has been increasing in recent years. Due to the insidious onset and strong local invasiveness of MPM, most patients are diagnosed in the late stage and early screening and treatment for high-risk populations are crucial. The treatment of MPM mainly includes surgery, chemotherapy, and radiotherapy. Immunotherapy and electric field therapy have also been applied, leading to further improvements in patient survival. The Mesothelioma Group of the Yangtze River Delta Lung Cancer Cooperation Group (East China LUng caNcer Group, ECLUNG; Youth Committee) developed a national consensus on the clinical diagnosis and treatment of MPM based on existing clinical research evidence and the opinions of national experts. This consensus aims to promote the homogenization and standardization of MPM diagnosis and treatment in China, covering epidemiology, diagnosis, treatment, and follow-up.
Topics: Humans; Consensus; East Asian People; Mesothelioma, Malignant; Pleural Neoplasms; China
PubMed: 37461124
DOI: 10.1111/1759-7714.15022 -
Ugeskrift For Laeger Apr 2018Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis. The disease is of importance, since the incidence in Denmark is increasing despite cessation... (Review)
Review
Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis. The disease is of importance, since the incidence in Denmark is increasing despite cessation of the use of asbestos in the 1980s. MPM has a long latency period, and the first symptom is often dyspnoea, typically caused by pleural effusion. The diagnosis is a challenge, because cytology often is non-conclusive, and thoracoscopy is needed to obtain biopsies for immunohistochemistry. The occupational history is important, since the patients are entitled to compensation. The treatment is often limited to palliation.
Topics: Asbestos; Denmark; Humans; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Occupational Exposure; Pleural Neoplasms; Prognosis; Workers' Compensation
PubMed: 29690982
DOI: No ID Found -
Clinical Medicine (London, England) May 2019Lung and pleural malignancies remain common in the UK with poor survival rates due, at least in part, to late stage diagnosis. Diagnostic pathways aim to reduce the time... (Review)
Review
Lung and pleural malignancies remain common in the UK with poor survival rates due, at least in part, to late stage diagnosis. Diagnostic pathways aim to reduce the time taken for patients to reach a diagnosis and treatment, with the use of positron emission tomography and endobronchial ultrasound to provide staging information alongside diagnostics. Advances in molecular phenotyping of tumours and the development of treatments to target these have provided new therapeutic options which can be individualised to patients. In the UK, screening for lung cancer remains in its infancy, but provides a promising possibility for capturing curative disease. We provide an overview of the diagnostic process, therapeutic options and potential future screening programmes in pleural and pulmonary malignancies.
Topics: Early Detection of Cancer; Humans; Lung Neoplasms; Pleural Neoplasms
PubMed: 31092517
DOI: 10.7861/clinmedicine.19-3-234 -
The Journal of Thoracic and... Jun 2022
Topics: Humans; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Pleural Neoplasms; Reference Standards
PubMed: 34600767
DOI: 10.1016/j.jtcvs.2021.08.077 -
The Journal of Thoracic and... Apr 2022
Topics: Antineoplastic Agents; Humans; Pleural Neoplasms
PubMed: 33454094
DOI: 10.1016/j.jtcvs.2020.12.015 -
International Journal of Molecular... May 2023Malignant Pleural Mesothelioma (MPM) is a rare neoplasm that is typically diagnosed in a locally advanced stage, making it not eligible for radical surgery and requiring... (Review)
Review
Malignant Pleural Mesothelioma (MPM) is a rare neoplasm that is typically diagnosed in a locally advanced stage, making it not eligible for radical surgery and requiring systemic treatment. Chemotherapy with platinum compounds and pemetrexed has been the only approved standard of care for approximately 20 years, without any relevant therapeutic advance until the introduction of immune checkpoint inhibitors. Nevertheless, the prognosis remains poor, with an average survival of only 18 months. Thanks to a better understanding of the molecular mechanisms underlying tumor biology, targeted therapy has become an essential therapeutic option in several solid malignancies. Unfortunately, most of the clinical trials evaluating potentially targeted drugs for MPM have failed. This review aims to present the main findings of the most promising targeted therapies in MPM, and to explore possible reasons leading to treatments failures. The ultimate goal is to determine whether there is still a place for continued preclinical/clinical research in this area.
Topics: Humans; Mesothelioma, Malignant; Mesothelioma; Lung Neoplasms; Pleural Neoplasms; Pemetrexed; Antineoplastic Combined Chemotherapy Protocols
PubMed: 37298116
DOI: 10.3390/ijms24119165 -
ESMO Open Mar 2020Malignant pleural mesothelioma is a rare and aggressive malignancy mostly associated with occupational asbestos exposure. Prognosis is poor and only highly selected... (Review)
Review
Malignant pleural mesothelioma is a rare and aggressive malignancy mostly associated with occupational asbestos exposure. Prognosis is poor and only highly selected patients may benefit from aggressive surgical management, also as part of a multimodal approach. In advanced disease, the combination of pemetrexed and platinum remains the only established treatment, while efficacy evidence of second line chemotherapy is lacking. Thus, a deeper knowledge of biology of the disease and more effective treatments are urgently needed. Refer to specialised centres with multidisciplinary expertise is mandatory, as well as inclusion of patients in clinical trials is advisable whenever possible. In all stages of disease focus on symptoms control is paramount.
Topics: Humans; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Pleural Neoplasms
PubMed: 32156681
DOI: 10.1136/esmoopen-2019-000669