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Current Opinion in Oncology Jan 2021Malignant pleural mesothelioma (MPM) is a rare, but aggressive tumor with still poor prognosis. In this article, we focus on recent developments in the management of MPM... (Review)
Review
PURPOSE OF REVIEW
Malignant pleural mesothelioma (MPM) is a rare, but aggressive tumor with still poor prognosis. In this article, we focus on recent developments in the management of MPM including diagnosis, staging, biomarkers, and treatment strategies.
RECENT FINDINGS
Molecular markers such as programmed death-ligand 1 (PDL-1), Breast Cancer gene 1-associated protein gene, and cyclin-dependent kinase inhibitor 2A (CDKN2A) have prognostic impact and should be considered for assessment in patient samples. In addition to histological subtype and tumor pattern, tumor volumetry plays an increasing important role in staging, assessment of treatment response, and prediction of survival. Several new blood-based biomarkers have been recently reported including peripheral blood DNA methylation, microRNAs, fibulin, and high-mobility group box 1, but have not been established in clinical routine use yet. Regarding treatment, targeted therapies, immunotherapy, and vaccination are considered as new promising strategies. Moreover, extended pleurectomy/decortication is favored over extrapleural pneumonectomy (EPP) and intensity-modulated radiotherapy represents a possible approach in combination with EPP and pleurectomy/decortication. Intracavitary treatment options are promising and deserve further investigations.
SUMMARY
Overall, there has not been a real breakthrough in the treatment of MPM. Further research and clinical trials are needed to evaluate outcome and to identify new potential treatment candidates.
Topics: Clinical Trials, Phase II as Topic; Clinical Trials, Phase III as Topic; Combined Modality Therapy; Humans; Mesothelioma, Malignant; Neoplasm Staging; Pleural Neoplasms; Randomized Controlled Trials as Topic
PubMed: 33186182
DOI: 10.1097/CCO.0000000000000697 -
The Annals of Thoracic Surgery Jan 1987Pleural mesotheliomas are uncommon tumors. Correct diagnosis of the benign variant is rarely made preoperatively, and resection is the treatment of choice and is... (Review)
Review
Pleural mesotheliomas are uncommon tumors. Correct diagnosis of the benign variant is rarely made preoperatively, and resection is the treatment of choice and is curative. Malignant pleural mesotheliomas are locally aggressive and difficult to treat. They may be seen clinically as localized pleural tumors or as diffuse pleural disease with effusion and encasement of the lung and obliteration of the pleural space. The localized forms of malignant mesotheliomas are fibrosarcomatous. Their diagnosis and treatment do not differ from those for soft-part sarcomas seen elsewhere. Wide en-bloc excision is the treatment of choice and can be curative. The diffuse forms of malignant mesotheliomas are mainly epithelial. Treatment is generally unsatisfactory, and long-term survival is rare. Two surgical approaches are currently available: an extrapleural pneumonectomy and a pleurectomy with irradiation. The authors favor the latter approach because of its wider applicability, lower morbidity rate, and better survival advantage. Steps in selecting the best surgical mode of treatment are presented.
Topics: Adolescent; Adult; Aged; Female; Fibrosarcoma; Humans; Male; Mesothelioma; Middle Aged; Neoplasm Invasiveness; Pleural Neoplasms; Pneumonectomy; Tomography, X-Ray Computed
PubMed: 3541812
DOI: 10.1016/s0003-4975(10)60182-8 -
European Journal of Radiology May 2000The vast majority of pleural neoplasms invade the pleura secondarily and can be seen in patients with bronchogenic carcinoma, breast cancer, lymphoma, and ovarian or... (Review)
Review
The vast majority of pleural neoplasms invade the pleura secondarily and can be seen in patients with bronchogenic carcinoma, breast cancer, lymphoma, and ovarian or gastric carcinoma. Primary pleural neoplasms are less common, although they have developed notoriety since the up-surge of malignant mesothelioma and the knowledge of its connection to asbestos exposure. Other malignant primary tumors include localized fibrous tumor and pleural liposarcoma. In most patients with diffuse malignant pleural disease the chest radiograph shows pleural effusion with or without pleural thickening. Computed tomography (CT) usually provides precise localization and extent of the disease and may be of value in assessing chest wall and mediastinal involvement. In specific situations, magnetic resonance (MR) may be useful as a problem-solving tool when CT findings of chest wall or diaphragmatic invasion are equivocal or in patients with contraindication to intravenous administration of ionic contrast material.
Topics: Asbestos; Carcinoma, Bronchogenic; Female; Humans; Liposarcoma; Magnetic Resonance Imaging; Male; Mesothelioma; Neoplasm Staging; Neoplasms, Fibrous Tissue; Pleural Neoplasms; Prognosis; Tomography, X-Ray Computed
PubMed: 10874176
DOI: 10.1016/s0720-048x(00)00168-6 -
Clinical Radiology Dec 2018There are various neoplasms and tumour-like conditions of the pleura. Mesothelioma is perhaps the most widely recognised; however, there are many others that are more... (Review)
Review
There are various neoplasms and tumour-like conditions of the pleura. Mesothelioma is perhaps the most widely recognised; however, there are many others that are more common and should be considered. Understanding the similarities and differences can be helpful in managing the patient with a newly found pleural lesion. We will discuss clinical symptoms at presentation and describe the imaging findings associated with these tumours, starting with conventional radiology, and correlating with computed tomography and combined positron-emission tomography (PET)/computed tomography (CT). Finally, imaging characteristics that help differentiation between the benign and malignant varieties will be reviewed.
Topics: Diagnosis, Differential; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Neoplasm Staging; Pleura; Pleural Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed
PubMed: 30064697
DOI: 10.1016/j.crad.2018.07.093 -
Current Oncology Reports Aug 2011Malignant pleural mesothelioma (MPM) is a relatively rare thoracic malignancy accounting for about 2000-3000 new cases per year. This cancer has been increasing in... (Review)
Review
Malignant pleural mesothelioma (MPM) is a relatively rare thoracic malignancy accounting for about 2000-3000 new cases per year. This cancer has been increasing in incidence and is strongly associated with asbestos exposure. Also, it is characterized by insidious growth and clinical presentation at an advanced stage of disease. In the past, the treatment of this disease was limited to marginally effective chemotherapy and morbid surgery. This review explores the clinical presentation of MPM, its diagnostic approach and the relevant and recent studies that define the role of chemotherapy, radiation, and various surgical options. Currently, even with aggressive surgical interventions and multimodality strategies, cure remains elusive, although life prolongation has been achieved. Additionally, promising new therapies and interventions that are currently being studied are introduced in this review.
Topics: Asbestos; Humans; Lung; Mesothelioma; Neoplasm Staging; Pleura; Pleural Neoplasms
PubMed: 21573909
DOI: 10.1007/s11912-011-0177-9 -
Diagnostic Cytopathology Jun 2021Malignant mesothelioma, a neoplasm arising within the serosal surfaces, has been linked closely to asbestos exposure. We present a case of 72-year-old male with a...
Malignant mesothelioma, a neoplasm arising within the serosal surfaces, has been linked closely to asbestos exposure. We present a case of 72-year-old male with a 27 year work-related history of asbestos exposure who presented with dyspnea. Chest computed tomography scan showed a large, right pleural effusion with compressive right lung atelectasis. Biopsies, subsequent pleurectomy and lung wedge resections revealed epithelioid malignant mesothelioma with associated focal non-keratinizing squamous-cell carcinoma, supported by extensive immunohistochemical stains and molecular studies. The patient was treated with 6 cycles of carboplatin/pemetrexed, showing no new metastases. Seven months post-treatment, the patient presented with progressive dyspnea and large pleural effusions. Bilateral pleural fluid was collected and showed malignant epithelioid cells, morphologically similar to the patient's pleural neoplastic cells. However, the tumor was positive for squamous cells markers and showed BAP1 loss, while negative for mesothelial markers. The findings support the diagnosis of squamous-cell carcinoma and were consistent with the patient's previously diagnosed pleural neoplastic origin. A malignant mesothelioma associated with squamous-cell carcinoma is a rare phenonmenon. To our knowledge, only two case reports are available in current literature. This unique case shows a single pleura tumor differentiating as both malignant mesothelioma and squamous-cell carcinoma. Squamous-cell carcinoma is the predominating malignancy seen within the bilateral pleural effusions, a potential pitfall for cytology specimen diagnosis.
Topics: Aged; Asbestos; Carcinoma, Squamous Cell; Cell Differentiation; Humans; Male; Mesothelioma, Malignant; Occupational Exposure; Pleural Neoplasms
PubMed: 33347735
DOI: 10.1002/dc.24686 -
Thoracic Surgery Clinics Nov 2020Staging of malignant pleural mesothelioma has been challenging because of a paucity of cases and poor survival. At least 5 staging systems were proposed before 1990... (Review)
Review
Staging of malignant pleural mesothelioma has been challenging because of a paucity of cases and poor survival. At least 5 staging systems were proposed before 1990 until the first consensus system was published in 1995. This system used tumor, node, metastasis designations and borrowed heavily from parenchymal lung cancer descriptors. With the establishment of a database to collect cases from 1995 to 2013, evidence-based revisions to the 1995 staging classification were published in 2016. With improving imaging technology, clinical staging will become more refined and, it is hoped, more useful for prognostication even without operative resection.
Topics: Humans; Mesothelioma, Malignant; Neoplasm Staging; Pleural Neoplasms; Prognosis
PubMed: 33012430
DOI: 10.1016/j.thorsurg.2020.07.001 -
American Journal of Health-system... Mar 2012PURPOSE The etiology, diagnosis, staging, and management of malignant pleural mesothelioma (MPM) are reviewed, with an emphasis on clinical trials of newer approaches to... (Review)
Review
UNLABELLED
PURPOSE The etiology, diagnosis, staging, and management of malignant pleural mesothelioma (MPM) are reviewed, with an emphasis on clinical trials of newer approaches to first-line, second-line, and adjuvant chemotherapy.
SUMMARY
In the past decade, more effective chemotherapy regimens have been developed for patients with MPM, a rapidly progressing disease linked to a history of asbestos exposure in about 70% of cases. Patients with MPM often require multimodal treatment with surgery, radiotherapy, and adjuvant or neoadjuvant (presurgical) chemotherapy. The current standard of first-line chemotherapy for MPM is cisplatin or carboplatin in combination with pemetrexed, an antifolate compound that has been shown to increase the cytotoxic effects of platinum-based drugs. In Phase II and III clinical trials, combination therapy with pemetrexed and either cisplatin or carboplatin yielded some of the highest rates of tumor response (21-41%) and overall survival (about 12-14 months) reported to date. Dual-agent neoadjuvant chemotherapy (cisplatin plus gemcitabine or pemetrexed) followed by radical surgery with or without radiotherapy has been reported to yield median survival of up to 23-29 months in small clinical trials, but larger randomized controlled studies are needed to better define the role of neoadjuvant therapy in MPM management. Other chemotherapeutic agents that have been used against MPM, with variable results, include gemcitabine, vinorelbine, taxanes, anthracyclines, and molecular-targeted agents.
CONCLUSION
Treatment approaches for MPM include surgery, radiation, and systemic chemotherapy. MPM carries a poor prognosis, but recent studies of pemetrexed and platinum analogue combination therapies have demonstrated improved response rates over other treatments.
Topics: Antineoplastic Agents; Chemotherapy, Adjuvant; Clinical Trials as Topic; Combined Modality Therapy; Humans; Mesothelioma; Neoplasm Staging; Pleural Neoplasms; Prognosis; Survival Rate; Treatment Outcome
PubMed: 22345416
DOI: 10.2146/ajhp110281 -
Annals of Oncology : Official Journal... Mar 2006
Review
Topics: Antineoplastic Combined Chemotherapy Protocols; Clinical Trials as Topic; Combined Modality Therapy; Humans; Medical Oncology; Mesothelioma; Neoplasm Staging; Pleural Neoplasms
PubMed: 16608972
DOI: 10.1093/annonc/mdj912 -
Radiographics : a Review Publication of... Nov 1992Although radiologic assessment of pleural tumors may be accomplished with several imaging modalities, the standard noninvasive techniques include chest radiography and... (Review)
Review
Although radiologic assessment of pleural tumors may be accomplished with several imaging modalities, the standard noninvasive techniques include chest radiography and computed tomography (CT). These examinations may be supplemented with magnetic resonance imaging and occasionally with ultrasound. Depending on the location, size, and underlying histologic features, pleural tumors may produce a spectrum of findings. CT is particularly useful in defining the location and extent of these masses. The authors present a review of basic pleural anatomy and imaging features of both benign and malignant pleural neoplasms. The pleural may be involved by one of several primary or metastatic tumors. Specific cell types are diffuse malignant mesothelioma (the most common plain radiographic findings are unilateral pleural effusion and pleural thickening), localized fibrous tumor (circumscribed, spherical or ovoid, noncalcified lesions arising in the pleural surface), metastatic disease (radiographic findings may mimic those of malignant mesothelioma), and uncommon neoplasms including thymoma and lymphoma. Among these various pleural tumors, metastatic disease represents the most common neoplasm.
Topics: Humans; Lymphoma; Mesothelioma; Pleural Neoplasms; Thymoma; Tomography, X-Ray Computed
PubMed: 1439021
DOI: 10.1148/radiographics.12.6.1439021