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Cancer Treatment and Research 2001Malignant pleural mesothelioma remains a difficult tumor to treat, much less cure. Currently, the best chance for long-term survival lies with early diagnosis and... (Comparative Study)
Comparative Study Review
Malignant pleural mesothelioma remains a difficult tumor to treat, much less cure. Currently, the best chance for long-term survival lies with early diagnosis and aggressive surgical extirpation, but given the typically long delay between the onset of symptoms and diagnosis, this is only possible with a high index of suspicion and an aggressive diagnosis workup. Early referral to a tertiary center experienced in the treatment of MPM may be important for several reasons: (1) decreased risk of tumor spread along multiple thoracenesis/biopsy tracts, (2) the availability of specialized pathologic assays for definitive diagnosis, (3) the availability of critical staging modalities (aggressive mediastinoscopy +/- thoracoscopy, MRI scans performed according to specific mesothelioma protocols, and perhaps PET scans), (4) surgical experience with pleurectomy/decortication and/or extrapleural pneumonectomy, that may decrease morbidity and mortality, and (5) the availability of novel adjuvant protocols. Single-modality therapy is unlikely to result in long-term survival. Aggressive surgery is required for optimal debulking, and extrapleural pneumonectomy may offer better local control compared with pleurectomy/ecortication. Delivery of optimal radiation schedules, which may involve large fractions as well as large total doses, is limited by the presence of nearby dose-limiting structures. Current chemotherapy is severely lacking in producing objective responses and improved survival although gemcitabine and IL-2 may be active agents to be combined with radiation and/or other agents. Hyperthermia, photodynamic therapy, intracavitary therapy, and gene therapy are all relatively new techniques under active investigation that should be supported by enrollment in on-going protocols. Predictably, many of these techniques provide greater benefit when used in the setting of adjuvant protocols or minimal residual disease, emphasizing the importance of multimodality therapy.
Topics: Adult; Aged; Animals; Anticarcinogenic Agents; Antineoplastic Combined Chemotherapy Protocols; Asbestos; Case-Control Studies; Combined Modality Therapy; Cricetinae; Cytokines; Diagnostic Imaging; Disease Progression; Drug Contamination; Female; Genetic Therapy; Humans; Hyperthermia, Induced; Interferons; Life Tables; Male; Mesothelioma; Mice; Mice, Nude; Middle Aged; Multicenter Studies as Topic; Neoplasm Staging; Neoplasms, Radiation-Induced; Occupational Diseases; Palliative Care; Photochemotherapy; Pleural Effusion, Malignant; Pleural Neoplasms; Poliovirus Vaccine, Inactivated; Randomized Controlled Trials as Topic; Risk Factors; Simian virus 40; Survival Analysis; Survival Rate; Treatment Outcome; Xenograft Model Antitumor Assays
PubMed: 11224994
DOI: 10.1007/978-1-4615-1589-0_13 -
The Journal of the Association of... Aug 2013
Topics: Adenocarcinoma; Female; Humans; Lung Neoplasms; Mesothelioma; Middle Aged; Neoplasm Invasiveness; Neoplasms, Second Primary; Palliative Care; Pleural Neoplasms; Radiography; Tongue Neoplasms
PubMed: 24818349
DOI: No ID Found -
Seminars in Ultrasound, CT, and MR Dec 2021Malignant pleural mesothelioma is a rare tumor arising from the pleural mesothelial cells. Imaging plays a crucial role in the diagnosis, staging, and management of... (Review)
Review
Malignant pleural mesothelioma is a rare tumor arising from the pleural mesothelial cells. Imaging plays a crucial role in the diagnosis, staging, and management of patients with mesothelioma. Accurate staging to stratify patients into homogeneous groups is required to evaluate the effectiveness of multimodality therapeutic regimens. CT and PET/CT are recommended for the initial staging of MPM. MRI adds value to further assess invasion of the tumor into the diaphragm, chest wall, and mediastinum. This review will discuss pearls and pitfalls in the imaging of mesothelioma with emphasis on the roles of CT, MRI, and PET/CT.
Topics: Humans; Mesothelioma, Malignant; Neoplasm Staging; Pleural Neoplasms; Positron Emission Tomography Computed Tomography; Tomography, X-Ray Computed
PubMed: 34895610
DOI: 10.1053/j.sult.2021.04.011 -
Respirology (Carlton, Vic.) Apr 2011Primary and metastatic pleural neoplasms, and non-neoplastic pleural diseases, can have similar clinical, radiographic and gross features. However, treatments and... (Review)
Review
Primary and metastatic pleural neoplasms, and non-neoplastic pleural diseases, can have similar clinical, radiographic and gross features. However, treatments and prognoses of these diverse pleural conditions vary greatly. Accurate diagnosis of pleural disease is therefore extremely important, and histological interpretation of pleural biopsies is vital to rendering an accurate diagnosis. Smaller biopsies contribute to the difficulties in accurately characterizing pleural lesions, and immunostains are frequently employed in their assessment. Diffuse malignant mesothelioma, the most common primary pulmonary neoplasm, is rare; however, other less common primary pleural neoplasms, including solitary fibrous tumour, the most common benign primary pleural neoplasm, occur. These neoplasms are discussed. Also, non-neoplastic pleural diseases, including granulomatous pleuritis, eosinophilic pleuritis and fibrous and fibrinous pleuritis, among other diseases, are discussed.
Topics: Female; Humans; Male; Mesothelioma; Pleura; Pleural Effusion; Pleural Neoplasms; Pleurisy; Pulmonary Medicine
PubMed: 21362105
DOI: 10.1111/j.1440-1843.2011.01957.x -
Der Chirurg; Zeitschrift Fur Alle... May 2016Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor disease, which rapidly leads to death if untreated. In Germany the incidence of newly occurring... (Review)
Review
Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor disease, which rapidly leads to death if untreated. In Germany the incidence of newly occurring disease is expected to reach a peak in the coming 5 years. An R0 resection for MPM is technically impossible; therefore, the aim of surgical procedures is to achieve the maximum amount of cytoreduction. There are two established surgical techniques for treatment of MPM, extrapleural pneumonectomy and tumor pleurectomy with decortication. The type and extent of surgery are currently controversially discussed. Within multimodal therapy concepts including cytoreductive surgery, long-term remission is possible in selected patients. When choosing the appropriate surgical therapy the high incidence of recurrence has to be borne in mind.
Topics: Cytoreduction Surgical Procedures; Follow-Up Studies; Humans; Mesothelioma; Neoplasm Recurrence, Local; Neoplasm Staging; Pleura; Pleural Neoplasms; Pneumonectomy; Thoracic Surgery, Video-Assisted; Thoracotomy
PubMed: 27169584
DOI: 10.1007/s00104-016-0186-1 -
Archives of Pathology & Laboratory... Jul 2008Overwhelmingly, the most common neoplasm involving the pleura is metastatic carcinoma. In contrast, diffuse malignant mesothelioma occurs relatively rarely; however, it... (Review)
Review
CONTEXT
Overwhelmingly, the most common neoplasm involving the pleura is metastatic carcinoma. In contrast, diffuse malignant mesothelioma occurs relatively rarely; however, it is nonetheless the most common neoplasm primary to the pleura. Metastatic carcinoma and diffuse malignant mesothelioma each have their own prognostic and therapeutic characteristics. Other primary pleural neoplasms occur uncommonly or rarely, with their own prognostic and therapeutic characteristics.
OBJECTIVE
To review primary pleural neoplasms other than diffuse malignant mesothelioma, to better ensure correct diagnosis and optimal assessment of prognosis and treatment.
DATA SOURCES
Literature review and primary material from the authors' institutions.
CONCLUSIONS
A nonexhaustive group of uncommon to rare benign and malignant primary pleural neoplasms--other than diffuse malignant mesothelioma--are presented, of which one must be aware in order to maintain an appropriate index of suspicion to include them in the differential diagnosis of a pleural tumor.
Topics: Diagnosis, Differential; Humans; Pleural Neoplasms; Prognosis
PubMed: 18605768
DOI: 10.5858/2008-132-1149-PPNEOT -
Seminars in Respiratory and Critical... Dec 2010A wide variety of local, regional, and systemic diseases may have pleural manifestations. The scope of this pathology encompasses a wide spectrum ranging from minimal... (Review)
Review
A wide variety of local, regional, and systemic diseases may have pleural manifestations. The scope of this pathology encompasses a wide spectrum ranging from minimal inflammatory changes to highly malignant neoplasms. An overview of the normal structure of the pleura is provided, along with the diseases that may be encountered. Pleural specimens from patients with pneumothorax are rarely encountered by pathologists. In contrast, pathologists frequently receive pleural specimens showing evidence of inflammation, repair, or neoplasm. In these circumstances, an awareness of less common (and often clinically highly important) conditions such as epithelioid hemangioendothelioma and primary pleural malignant mesothelioma is essential. Knowledge of the clinical setting (e.g., disease tempo) and radiological picture (e.g., laterality) is often of great value to the pathologist in arriving at a correct diagnosis. Similarly, knowledge of the normal anatomical considerations and familiarity with the expected pleural histopathology for the most clinically relevant pleural diseases are critical assets for pulmonary physicians in providing optimal care for their patients.
Topics: Humans; Inflammation; Pleura; Pleural Diseases; Pleural Neoplasms; Pneumothorax
PubMed: 21213198
DOI: 10.1055/s-0030-1269826 -
Cancer Treatment Reviews Nov 2011Malignant pleural mesothelioma is a highly aggressive cancer with a very poor prognosis. Although the mechanism of carcinogenesis is not fully understood, approximately... (Review)
Review
Malignant pleural mesothelioma is a highly aggressive cancer with a very poor prognosis. Although the mechanism of carcinogenesis is not fully understood, approximately 80% of malignant pleural mesothelioma can be attributed to asbestos fiber exposure. This disease is largely unresponsive to conventional chemotherapy or radiotherapy, and most patients die within 10-17 months of their first symptoms. Currently, malignant pleural mesothelioma therapy is guided by clinical stage and patient characteristics rather than by the histological or molecular features of the tumor. Several molecular pathways involved in malignant pleural mesothelioma have been identified; these include cell cycle regulation, apoptosis, growth factor pathways, and angiogenesis. Unfortunately, several agents targeting these processes, including erlotinib, gefitinib, and imatinib, have proven ineffective in clinical trials. A greater understanding of the molecular pathways involved in malignant pleural mesothelioma is needed to develop better diagnostics, therapeutics, and preventative measures. Moreover, understanding the biological basis of mesothelioma progression may facilitate personalized treatment approaches, and early identification of poor prognostic indicators may help reduce the heterogeneity of the clinical response. This paper reviews advances in the molecular biology of malignant pleural mesothelioma in terms of pathogenesis, the major molecular pathways and the associated therapeutic strategies, and the roles of biomarkers.
Topics: Antineoplastic Agents; Clinical Trials as Topic; Humans; Mesothelioma; Neoplasm Proteins; Pleural Effusion, Malignant; Pleural Neoplasms; Signal Transduction
PubMed: 21288646
DOI: 10.1016/j.ctrv.2011.01.001 -
Annals of Oncology : Official Journal... 1995Lung cancer presenting with ipsilateral pleural effusion is considered to have a poor prognosis. Thoracoscopy has been invoked as a useful tool for staging those cases... (Review)
Review
Lung cancer presenting with ipsilateral pleural effusion is considered to have a poor prognosis. Thoracoscopy has been invoked as a useful tool for staging those cases before proceeding to thoracotomy, especially in patients with large pleural effusions. In cases where there is only a small effusion or no effusion at all, direct thoracotomy would be the choice, with pleural lavage during the operation and immediate cytology investigation. We performed thoracoscopy in 76 patients with lung cancer and ipsilateral pleural effusion (55 cytologically positive and the remaining negative), and we found only five cases with potentially resectable tumor. They were submitted to thoracotomy and resection could be accomplished in none of them, due to direct mediastinal tumor invasion. On the other hand, we found visceral pleura involvement without effusion in 31 out of 167 patients submitted to thoracotomy for lung cancer in our Institution. The tumor could be resected in all but one of these cases. Talc pleurodesis was performed in all patients who were found to have pleural effusion and non-resectable tumor at thoracoscopy, and we obtained a 68% success rate in cases with no trapped lung, as opposed to 56% in patients with trapped lung (massively covered by fibrin and/or tumor). Pleural fluid glucose and pH are good predictors of the outcome of pleurodesis.
Topics: Cytodiagnosis; Humans; Lung Neoplasms; Neoplasm Staging; Pleural Effusion, Malignant; Pleural Neoplasms; Thoracoscopy
PubMed: 8616109
DOI: 10.1093/annonc/6.suppl_3.s25 -
Lung Cancer (Amsterdam, Netherlands) Aug 2004Both asbestos and erionite related malignant pleural mesothelioma (MPM) is a serious health problem in Turkey. Erionite has a higher potency in the lung than asbestos... (Review)
Review
Both asbestos and erionite related malignant pleural mesothelioma (MPM) is a serious health problem in Turkey. Erionite has a higher potency in the lung than asbestos and familial clustering of malignant mesothelioma suggests a genetic predisposition to this cancer among affected individuals. Neither Simian virus 40 (SV40) nor human herpes virus 8 (HHV-8) are co-factors in the pathenogenesis of environmentally induced mesothelioma. A survival advantage has been demonstrated in patients with asbestos-induced mesothelioma compared with erionite-induced mesothelioma. This together with the proliferation index (PI) can be used as an independent prognostic factor for patients with malignant pleural mesothelioma. It is envisaged that the application of these prognostic approaches together with the new TNM staging system will allow investigations to be more precisely carried out and evaluated.
Topics: Asbestos; Environmental Exposure; Genetic Predisposition to Disease; Humans; Mesothelioma; Neoplasm Staging; Pleural Neoplasms; Prognosis; Turkey; Zeolites
PubMed: 15261427
DOI: 10.1016/j.lungcan.2004.04.009