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Kondo N, Hasegawa S. Optimal surgery for resectable malignant pleural mesothelioma in the setting of multimodality treatment. Surg Today 2024; 54:663-669. [PMID: 37474704 PMCID: PMC11189979 DOI: 10.1007/s00595-023-02723-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 06/18/2023] [Indexed: 07/22/2023]
Abstract
The surgical treatment of malignant pleural mesothelioma (MPM) involves procedures to achieve macroscopic complete resection, depending on the patient's condition. We reviewed the evolution of surgical approaches for resectable MPM. Since surgery is no more than a single step in the set of processes in multimodality treatment (MMT), we concluded that these procedures should give precedence to lung preservation and minimize resection whenever possible. Postoperative quality of life must be prioritized when the patient can receive appropriate adjuvant therapy.
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Affiliation(s)
- Nobuyuki Kondo
- Department of Thoracic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan
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2
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Porcel JM. Pleural mesothelioma: surgery questioned again? Eur Respir J 2024; 63:2400896. [PMID: 38942440 DOI: 10.1183/13993003.00896-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 06/30/2024]
Affiliation(s)
- José M Porcel
- Pleural Medicine and Clinical Ultrasound Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, Lleida, Spain
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3
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Hasegawa S, Shintani Y, Takuwa T, Aoe K, Kato K, Fujimoto N, Hida Y, Morise M, Moriya Y, Morohoshi T, Suzuki H, Chida M, Endo S, Kadokura M, Okumura M, Hattori S, Date H, Yoshino I. Nationwide prospective registry database of patients with newly diagnosed untreated pleural mesothelioma in Japan. Cancer Sci 2024; 115:507-528. [PMID: 38047872 PMCID: PMC10859622 DOI: 10.1111/cas.16021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023] Open
Abstract
Due to the scarcity of large-sized prospective databases, the Japanese Joint Committee for Lung Cancer Registry conducted a nationwide prospective registry for newly diagnosed and untreated pleural mesothelioma. All new cases diagnosed pathologically as any subtype of pleural mesothelioma in Japan during the period between April 1, 2017, to March 31, 2019, were included before treatment. Data on survival were collected in April 2021. The eligible 346 patients (285 men [82.3%]; 61 women [17.7%]; median age, 71.0 years [range, 44-88]) were included for analysis. Among these patients, 138 (39.9%) underwent surgery, 164 (47.4%) underwent non-surgical therapy, and the remaining 44 (12.7%) underwent best supportive care. The median overall survival for all 346 patients was 19.0 months. Survival rates at 1, 2, and 3 years for all patients were, 62.8%, 42.3%, and 26.5%, respectively. Median overall survival was significantly different among patients undergoing surgery, non-surgical treatment, and best supportive care (32.2 months vs. 14.0 months vs. 3.8 months, p < 0.001). The median overall survival of patients undergoing pleurectomy/decortication and extrapleural pneumonectomy was 41.8 months and 25.0 months, respectively. Macroscopic complete resection resulted in longer overall survival than R2 resection and partial pleurectomy/exploratory thoracotomy (41.8 months vs. 32.2 months vs. 16.8 months, p < 0.001). Tumor shape, maximum tumor thickness, and sum of three level thickness were significant prognostic factors. The data in the prospective database would serve as a valuable reference for clinical practice and further studies for pleural mesothelioma.
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Affiliation(s)
- Seiki Hasegawa
- Department of Thoracic SurgeryHyogo Medical UniversityHyogoJapan
| | - Yasushi Shintani
- Department of General Thoracic SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Teruhisa Takuwa
- Department of Thoracic SurgeryHyogo Medical UniversityHyogoJapan
| | - Keisuke Aoe
- Department of Medical OncologyNational Hospital Organization Yamaguchi‐Ube Medical CenterYamaguchiJapan
| | - Katsuya Kato
- Department of Diagnostic Radiology 2Kawasaki Medical SchoolOkayamaJapan
| | | | - Yasuhiro Hida
- Department of Cardiovascular and Thoracic SurgeryHokkaido University Graduate School of MedicineHokkaidoJapan
| | - Masahiro Morise
- Department of Respiratory MedicineNagoya University Graduate School of MedicineAichiJapan
| | - Yasumitsu Moriya
- Division of General Thoracic SurgeryChiba Rosai HospitalChibaJapan
| | - Takao Morohoshi
- Division of General Thoracic SurgeryYokosuka‐Kyosai HospitalKanagawaJapan
| | - Hidemi Suzuki
- Department of General Thoracic SurgeryChiba University Graduate School of MedicineChibaJapan
| | - Masayuki Chida
- Department of General Thoracic SurgeryDokkyo Medical UniversityTochigiJapan
| | - Shunsuke Endo
- Department of Thoracic SurgeryJichi Medical UniversityShimotsukeJapan
| | - Mitsutaka Kadokura
- Division of Chest Surgery, Department of SurgeryShowa University School of MedicineTokyoJapan
| | - Meinoshin Okumura
- Department of General Thoracic SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Satoshi Hattori
- Department of Biomedical StatisticsOsaka University Graduate School of MedicineOsakaJapan
| | - Hiroshi Date
- Department of Thoracic SurgeryKyoto University HospitalKyotoJapan
| | - Ichiro Yoshino
- Department of General Thoracic SurgeryChiba University Graduate School of MedicineChibaJapan
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4
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de Miguel-Perez D, Pickering EM, Malapelle U, Grier W, Pepe F, Pisapia P, Russo G, Pinto JA, Russo A, Troncone G, Culligan MJ, Scilla KA, Mehra R, Mohindra P, Arrieta O, Cardona AF, Del Re M, Sachdeva A, Hirsch FR, Wolf A, Friedberg JS, Rolfo C. Genomic profiling of tissue and blood predicts survival outcomes in patients with resected pleural mesothelioma. Eur J Cancer 2024; 196:113457. [PMID: 38008032 DOI: 10.1016/j.ejca.2023.113457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Pleural mesothelioma (PM) is an aggressive tumor still considered incurable, in part due to the lack of predictive biomarkers. Little is known about the clinical implications of molecular alterations in resectable PM tissues and blood. Here, we characterized genetic alterations to identify prognostic and predictive biomarkers in patients with resected PM. EXPERIMENTAL DESIGN Targeted next-generation sequencing was performed in retrospective pleural tumor tissue and paired plasma samples from stage IB-IIIB resected PM. Association between prognosis and presence of specific mutations was validated in silico. RESULTS Thirty PM tissues and paired blood samples from 12 patients were analyzed. High tissue tumor mutational burden (TMB) (>10 mutations/Mb), tissue median minor allele frequency (MAF) (>9 mutations/Mb), and blood TMB (>6 mutations/Mb), tissue KMT2C, PBRM1, PKHD1,EPHB1 and blood LIFR mutations correlated with longer disease-free survival and/or overall survival. High concordance (>80%) between tissue and blood was found for some mutations. CONCLUSIONS Tissue TMB and MAF, blood TMB, and specific mutations correlated with outcomes in patients with resected PM and should be further studied to validate their role as prognostic biomarkers and potentially predictive factors for combinations with immune-checkpoint inhibitors. This suggest that molecular profiling could identify longer survivors in patients with resected PM.
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Affiliation(s)
- Diego de Miguel-Perez
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edward M Pickering
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Umberto Malapelle
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - William Grier
- Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Francesco Pepe
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Gianluca Russo
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Joseph A Pinto
- Centro de Investigación Básica y Traslacional, Auna Ideas, Lima, Peru
| | - Alessandro Russo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Giancarlo Troncone
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Melissa J Culligan
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, USA
| | - Katherine A Scilla
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ranee Mehra
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Andres F Cardona
- Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center (CTIC) / Foundation for Clinical and Applied Cancer Research (FICMAC) / Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Marzia Del Re
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh Sachdeva
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Fred R Hirsch
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea Wolf
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph S Friedberg
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, USA
| | - Christian Rolfo
- Center for Thoracic Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.
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Okubo K, Ishibashi H, Wakejima R, Baba S, Asakawa A, Seshima H. Extended pleurectomy/decortication and hyperthermic intraoperative intrapleural cisplatin perfusion for malignant pleural mesothelioma. JTCVS OPEN 2023; 16:977-986. [PMID: 38204668 PMCID: PMC10775036 DOI: 10.1016/j.xjon.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 01/12/2024]
Abstract
Objective To evaluate the efficacy of multimodality treatment including extended pleurectomy/decortication (P/D) and hyperthermic intraoperative chemotherapy (HIOC) with cisplatin for malignant pleural mesothelioma (MPM), we investigated the pharmacokinetics of platinum, adverse events after HIOC, and survival outcome. Methods Fifty-three patients with pathologically diagnosed MPM (cT1-3N0-1M0, excluding sarcomatoid) underwent an extended P/D and HIOC (cisplatin 80 mg/m2 in saline 2 L, 42°C, 60 minutes) since 2011. The protocol includes postoperative 4 cycles of cisplatin and pemetrexed. Platinum concentrations in the perfusate (before and after) and the serum (1, 2, 4, 8, 24, 48, 72 hours after perfusion) were measured in 10 patients. Mortality and morbidity, especially adverse events of renal function, were investigated, and survival and affecting factors were examined. Results All patients obtained macroscopic complete resection and pathologic staging revealed as follows: T1/2/3/4: 12/8/23/10, N0/1: 36/17, stage 1A/1B-3A/3B: 12/31/10, respectively. Platinum concentrations in the perfusate indicated that 28% of the dose remained in the pleural cavity, and the maximum concentration in the serum was 0.91 μg/mL. Six patients (11%) showed elevated max-creatinine (>2 mg/dL) postoperatively. Two patients (4%) received renal-replacement therapy, and one was weaned before discharge. There was no 30-day mortality and one in-hospital death (1.9%). Forty-six patients (87%) received multiple cycles of perioperative systemic chemotherapy. Median overall survival (OS) and disease-free survival (DFS) were 52.4 months and 18.7 months. Patents with stage 1A demonstrated a 5-year OS of 67.3% and a median DFS of 67.1 months, and patients with stage 1B-3A demonstrated a 5-year OS of 50.1% and a median DFS of 20.4 months. Univariate analysis showed histological subtype, p-T, p-stage, and multimodality treatment as significant factors affecting OS. Multivariate analysis revealed histology, p-stage, and multimodality as independent. Conclusions Extended P/D and HIOC with cisplatin for MPM is acceptable with limited acute kidney injury. This multimodality protocol provides promising favorable survival for stage 1A-3A disease.
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Affiliation(s)
- Kenichi Okubo
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hironori Ishibashi
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryo Wakejima
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunichi Baba
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayaka Asakawa
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Seshima
- Department of Clinical Engineering, Tokyo Medical and Dental University, Tokyo, Japan
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Ripley RT, Holmes HM, Whitlock RS, Groth SS, Medina CG, Choi EA, Burt BM, Sugarbaker PH. Pleurectomy and decortication are associated with better survival for bicavitary cytoreductive surgery for mesothelioma compared with extrapleural pneumonectomy. J Thorac Cardiovasc Surg 2023; 165:1722-1730. [PMID: 36740497 DOI: 10.1016/j.jtcvs.2022.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Mesothelioma is a nearly uniformly fatal tumor. Multimodality therapy including cytoreductive surgery and chemotherapy is associated with long-term survival in some patients. Cytoreductive surgery for thoracic disease includes a lung-sparing operation called an "extended pleurectomy/decortication" or a lung-sacrificing surgery called an "extrapleural pneumonectomy." The benefit of cytoreductive surgery for bicavitary disease (chest and abdomen) is poorly understood. Our objective was to evaluate the long-term survivals for patients undergoing cytoreductive surgery for bicavitary disease and to determine whether any prognostic factors were associated with outcome. METHODS We reviewed our Institutional Review Board-approved, institutional, International Association for the Study of Lung Cancer Mesothelioma Staging Project database. Inclusion criteria were all patients who underwent cytoreductive surgery for bicavitary disease. Overall survival was calculated by Kaplan-Meier methodology. All International Association for the Study of Lung Cancer database elements were evaluated by univariable analysis. RESULTS From February 2014 to August 2021, 440 patients with mesothelioma were evaluated. Fourteen patients (3%) underwent cytoreductive surgery of both chest and abdomen as a planned 2-stage operation. Most patients (13/14; 93%) underwent chest surgery before abdomen surgery. For the entire cohort, the median overall survival was 33.6 months with a 5-year survival of 20%. Extended pleurectomy/decortication was associated with a better outcome compared with extrapleural pneumonectomy, with median overall survivals of 58.2 versus 13.5 months, respectively. CONCLUSIONS For a highly selected group of patients with bicavitary mesothelioma, long-term survival can be achieved with an aggressive, staged surgical approach. The patients who undergo extended pleurectomy/decortication with preservation of the lung appear to have more favorable outcomes compared with patients undergoing extrapleural pneumonectomy.
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Affiliation(s)
- R Taylor Ripley
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
| | - Hudson M Holmes
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Richard S Whitlock
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Shawn S Groth
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Cristian G Medina
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Eugene A Choi
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Bryan M Burt
- Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Paul H Sugarbaker
- Center for Gastrointestinal Malignancy, MedStar Washington Hospital Center, Washington, DC
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Paajanen J, Jaklitsch MT, Bueno R. Contemporary issues in the surgical management of pleural mesothelioma. J Surg Oncol 2023; 127:343-354. [PMID: 36630097 PMCID: PMC9839311 DOI: 10.1002/jso.27152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 01/12/2023]
Abstract
The surgical management of pleural mesothelioma (PM) can be divided into diagnostic, staging, palliation, and cytoreductive surgery. In the cytoreductive surgical setting, the combination of different treatment modalities has led to better outcomes than surgery alone. The scarcity of high-quality studies has led to heterogeneity in management of PM across the mesothelioma treatment centers. Here, we review the literature regarding the most important open questions and ongoing clinical trials.
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Affiliation(s)
- Juuso Paajanen
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program (www.impmeso.org), Division of Thoracic Surgery and the Lung Center, Brigham and Women’s Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Michael T. Jaklitsch
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program (www.impmeso.org), Division of Thoracic Surgery and the Lung Center, Brigham and Women’s Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Raphael Bueno
- The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program (www.impmeso.org), Division of Thoracic Surgery and the Lung Center, Brigham and Women’s Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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8
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Gong D, Yu J, Jiang X. Case report: Rare intrapulmonary malignant mesothelioma complicated with myositis. Front Oncol 2022; 12:1074821. [PMID: 36620605 PMCID: PMC9815530 DOI: 10.3389/fonc.2022.1074821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Malignant pleural mesothelioma is an uncommon aggressive tumor. Its incidence is even lower when the lung parenchyma is the primary site. Myositis is a common paraneoplastic syndrome, but it rarely presents with malignant pleural mesothelioma. This report presents a rare intrapulmonary malignant mesothelioma complicated by cancer-associated myositis. The patient presented with limb muscle weakness as the first symptom and was diagnosed with intrapulmonary malignant mesothelioma complicated by cancer-associated myositis on the basis of clinical, histological, immunohistochemical, and radiological findings. The patient responded poorly to conventional hormone therapy and died of respiratory failure within 2 months after the first presence of limb muscle weakness.
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Lee M, Ventura L, Baranowski R, Hargrave J, Waller D. The Effects of Preserving the Diaphragm on Early and Late Outcome of Lung-Sparing Radical Surgery for Malignant Pleural Mesothelioma. J Clin Med 2022; 11:jcm11226839. [PMID: 36431316 PMCID: PMC9697121 DOI: 10.3390/jcm11226839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/12/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The accepted aim of radical surgery for malignant pleural mesothelioma (MPM) is the achievement of macroscopic complete resection (MCR) whilst reducing perioperative morbidity by preserving normal tissue. Whilst preservation of the lung by pleurectomy/decortication (PD) has become widely utilised, there remains debate regarding the management of the diaphragm. Muscle-sparing complete excision of the diaphragmatic pleura is technically challenging; thus, surgeons may proceed to extended PD with phrenectomy and possible increased morbidity or to preserve the diaphragmatic pleura at the expense of MCR with potential survival deficit. We aimed to evaluate the effects of an intentional change in protocol to diaphragm-sparing PD whilst maintaining MCR as the treatment of choice for MPM. METHODS In a series of 136 patients (111M:25F, median age 68(63-73) years) undergoing radical surgery for MPM, we identified 28 patients (22M:6F, median age 67(60-71) years) in whom MCR was achieved without phrenectomy (PD group). We compared their perioperative outcomes and survival with a historical control group of 18 patients (18M:0F, median age 69(57-78) years) in whom MCR had been achieved with phrenectomy (EPD group) but in whom there was no histological evidence of diaphragm muscle invasion and who, in retrospect, could have undergone muscle-sparing MCR if this procedure had been attempted. RESULTS There was no significant intergroup difference in demographics or tumour cell type; the majority of both groups were found to be epithelial (PD 85.7%, EPD 77.8%). The EPD group was found to be more locally advanced (T3 55.56%) than the PD group (T1 46.43%) (p = 0.03). All the following parameters were significantly reduced after PD compared to EPD: operative time (188 vs. 220 min, p = 0.007); duration of air leak (5 vs. 10 days, p = 0.001), duration of inotrope (p = 0.009) and post-operative hospital stay (8 vs. 13 days, p = 0.034). There were no significant differences (p = 0.123) in overall survival (OS) between the two groups, but the median survival in the PD group had not been reached at a median follow up of 33.9 (24.2-46) months. CONCLUSIONS A surgical strategy of attempting to spare the diaphragm whilst still achieving MCR wherever possible is justified by improved perioperative outcomes without compromising OS.
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Ho S, Culligan M, Friedberg J, Goloubeva O, Marchese V. Examining the impact of physical function performance in predicting patient outcomes after lung-sparing surgery for malignant pleural mesothelioma. Disabil Rehabil 2022; 44:6676-6683. [PMID: 34455883 DOI: 10.1080/09638288.2021.1970256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to examine the impact of physical function performance and pulmonary function on patient outcomes after lung-sparing surgery for malignant pleural mesothelioma (MPM). MATERIALS AND METHODS A retrospective review of 54 patients with MPM from 2015 to 2020 was performed. The primary objective was to assess whether physical function, as measured by the Eastern Cooperative Oncology Group Performance Status (ECOG), and pulmonary function tests were predictive of postoperative patient outcomes (ventilator days, chest tube days, hospital length of stay). A secondary objective was to explore demographic and preoperative variables that best predict postoperative physical function and patient outcomes. RESULTS Data include 54 patients who underwent extended pleurectomy-decortication. Preoperative ECOG was a significant predictor of postoperative patient outcomes while preoperative lung function lacked predictive ability. Preoperative ECOG was also predictive of preoperative lung function. Age on the day of surgery was the best predictor of postoperative physical function, which was significantly reduced postoperatively. CONCLUSIONS Preoperative physical function performance was a significant predictor of postoperative outcomes. The results of our study highlight the importance of physical function in patients with MPM and support the need for early rehabilitation and further research to determine optimal rehabilitation interventions.IMPLICATIONS FOR REHABILITATIONPreoperative physical function can predict outcomes after lung-sparing surgery for malignant pleural mesothelioma (MPM).Physical function in patients with MPM should be carefully examined.To accurately reflect patients' abilities, patient assessment should include both patient-reported outcomes and performance-based measures.Patients with MPM should receive rehabilitation early after diagnosis and throughout the continuum of care.
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Affiliation(s)
- Simon Ho
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa Culligan
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Joseph Friedberg
- Division of Thoracic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Olga Goloubeva
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.,Division of Biostatistics and Bioinformation, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA.,University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
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11
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Multifactorial Evaluation following Cytoreductive Surgery for Malignant Pleural Mesothelioma in Patients with High Symptom-Burden. J Clin Med 2022; 11:jcm11216418. [DOI: 10.3390/jcm11216418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
Mesothelioma has a scant prognosis and a great impact on symptoms and the quality of life. Pleurectomy/decortication and extrapleural pneumonectomy are the two cytoreductive surgical strategies, with different invasiveness, but achieving similar oncological results. Hereafter, the two surgical procedures effects on symptoms and the quality of life are compared in a high symptom-burden population. Between 2003 and 2017, 55 consecutive patients underwent pleurectomy/decortication (n = 26) or extrapleural pneumonectomy (n = 29), both followed by adjuvant chemo-radiotherapy. Cardio-pulmonary function, symptoms and the quality of life (Short-Form-36 and St.George’s questionnaires) were evaluated pre- and 3-, 6-, 12- and 24-months postoperatively. Extrapleural pneumonectomy demonstrated lower pain at 12 months but a higher decrement of forced vital capacity at 24 months than pleurectomy/decortication. Both procedures revealed a 3-months improvement of many symptoms and the quality of life determinants. Improvement in physical, social and pain-related measured parameters lasted for a longer time-spawn in the extrapleural pneumonectomy group. No differences were found in chemotherapy compliance and survival between groups. Age-at-presentation (p = 0.02) and non-epitheliod histology (p = 0.10) were the only significant prognosticators. Surgery, despite poor survival results, improved symptoms and the quality of life in patients with mesothelioma with high symptom-burden at diagnosis. Therefore, extrapleural pneumonectomy demonstrated the most durable effects.
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12
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Vitto VAM, Bianchin S, Zolondick AA, Pellielo G, Rimessi A, Chianese D, Yang H, Carbone M, Pinton P, Giorgi C, Patergnani S. Molecular Mechanisms of Autophagy in Cancer Development, Progression, and Therapy. Biomedicines 2022; 10:biomedicines10071596. [PMID: 35884904 PMCID: PMC9313210 DOI: 10.3390/biomedicines10071596] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 01/18/2023] Open
Abstract
Autophagy is an evolutionarily conserved and tightly regulated process that plays an important role in maintaining cellular homeostasis. It involves regulation of various genes that function to degrade unnecessary or dysfunctional cellular components, and to recycle metabolic substrates. Autophagy is modulated by many factors, such as nutritional status, energy level, hypoxic conditions, endoplasmic reticulum stress, hormonal stimulation and drugs, and these factors can regulate autophagy both upstream and downstream of the pathway. In cancer, autophagy acts as a double-edged sword depending on the tissue type and stage of tumorigenesis. On the one hand, autophagy promotes tumor progression in advanced stages by stimulating tumor growth. On the other hand, autophagy inhibits tumor development in the early stages by enhancing its tumor suppressor activity. Moreover, autophagy drives resistance to anticancer therapy, even though in some tumor types, its activation induces lethal effects on cancer cells. In this review, we summarize the biological mechanisms of autophagy and its dual role in cancer. In addition, we report the current understanding of autophagy in some cancer types with markedly high incidence and/or lethality, and the existing therapeutic strategies targeting autophagy for the treatment of cancer.
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Affiliation(s)
- Veronica Angela Maria Vitto
- Laboratory for Technologies of Advanced Therapies (LTTA), Department of Medical Science, University of Ferrara, 44121 Ferrara, Italy; (V.A.M.V.); (S.B.); (G.P.); (A.R.); (D.C.); (P.P.)
| | - Silvia Bianchin
- Laboratory for Technologies of Advanced Therapies (LTTA), Department of Medical Science, University of Ferrara, 44121 Ferrara, Italy; (V.A.M.V.); (S.B.); (G.P.); (A.R.); (D.C.); (P.P.)
| | - Alicia Ann Zolondick
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI 96816, USA; (A.A.Z.); (H.Y.); (M.C.)
- Department of Molecular Biosciences and Bioengineering, University of Hawai’i at Manoa, Honolulu, HI 96816, USA
| | - Giulia Pellielo
- Laboratory for Technologies of Advanced Therapies (LTTA), Department of Medical Science, University of Ferrara, 44121 Ferrara, Italy; (V.A.M.V.); (S.B.); (G.P.); (A.R.); (D.C.); (P.P.)
| | - Alessandro Rimessi
- Laboratory for Technologies of Advanced Therapies (LTTA), Department of Medical Science, University of Ferrara, 44121 Ferrara, Italy; (V.A.M.V.); (S.B.); (G.P.); (A.R.); (D.C.); (P.P.)
| | - Diego Chianese
- Laboratory for Technologies of Advanced Therapies (LTTA), Department of Medical Science, University of Ferrara, 44121 Ferrara, Italy; (V.A.M.V.); (S.B.); (G.P.); (A.R.); (D.C.); (P.P.)
| | - Haining Yang
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI 96816, USA; (A.A.Z.); (H.Y.); (M.C.)
| | - Michele Carbone
- Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, HI 96816, USA; (A.A.Z.); (H.Y.); (M.C.)
| | - Paolo Pinton
- Laboratory for Technologies of Advanced Therapies (LTTA), Department of Medical Science, University of Ferrara, 44121 Ferrara, Italy; (V.A.M.V.); (S.B.); (G.P.); (A.R.); (D.C.); (P.P.)
| | - Carlotta Giorgi
- Laboratory for Technologies of Advanced Therapies (LTTA), Department of Medical Science, University of Ferrara, 44121 Ferrara, Italy; (V.A.M.V.); (S.B.); (G.P.); (A.R.); (D.C.); (P.P.)
- Correspondence: (C.G.); (S.P.)
| | - Simone Patergnani
- Laboratory for Technologies of Advanced Therapies (LTTA), Department of Medical Science, University of Ferrara, 44121 Ferrara, Italy; (V.A.M.V.); (S.B.); (G.P.); (A.R.); (D.C.); (P.P.)
- Correspondence: (C.G.); (S.P.)
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13
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What has changed in malignant mesothelioma between 1990 and 2019? A time- series analyses in Turkey. Int J Clin Oncol 2022; 27:1202-1211. [PMID: 35445912 DOI: 10.1007/s10147-022-02168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/03/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To investigate the changes in epidemiological and survival characteristics of malignant mesothelioma (MM) cases diagnosed in a 30-year period between 1990 and 2019. METHODS Data were analyzed considering three time periods (1990-1999, 2000-2009, 2010-2019) when treatment practices changed. The Join point Regression Program was used to analyze the change in clinical and epidemiological characteristics of the cases. Kaplan-Meier analysis was used to calculate the overall survival of the patients. Cox regression analysis was used to determine the effect of variables on survival. RESULTS The study group consisted of 928 MM patients. During the study period, the mean age of the patients and the percentage of epithelioid subtype increased, while the percentage of female and histopathologically unidentified cases decreased. The median survival (95%CI) of patients according to the study periods was 9.0 (7.2-10.9), 9.0 (7.6-10.4) and 12.0 (10.5-13.5) months, respectively. A significant increase in overall survival was observed in the time trend (p = 0.013). There was no significant change in overall survival in patients receiving best supportive care over the 30-year period (p = 0.060), but an improvement of 1.4 (95%CI 0.2 to 2.7) months (p = 0.027) was observed in patient receiving chemotherapy. An improvement in overall survival of 4.8 (1.2 to 8.4) months was also observed in patients receiving multimodality treatment during 2000-2019 (p = 0.014). MM patients who were younger, female, diagnosed after 2000, epithelioid subtype, early stage, and received chemotherapy or multimodal treatment had longer survival. CONCLUSIONS It was found that histopathological diagnosis and treatment success in MM have improved over the years.
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14
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Tsao AS, Pass HI, Rimner A, Mansfield AS. New Era for Malignant Pleural Mesothelioma: Updates on Therapeutic Options. J Clin Oncol 2022; 40:681-692. [PMID: 34985934 PMCID: PMC8853621 DOI: 10.1200/jco.21.01567] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare malignancy with few treatment options. Recent advances have led to US Food and Drug Administration approvals and changes in the standard of care with a novel biomedical device approved for use with platinum-pemetrexed, and also for immunotherapy agents to be included as a frontline treatment option in unresectable disease. Although predictive biomarkers for systemic therapy are not currently in use in clinical practice, it is essential to correctly identify the MPM histology to determine an optimal treatment plan. Patients with nonepithelioid MPM may have a greater magnitude of benefit to dual immunotherapy checkpoint inhibitors and this regimen should be preferred in the frontline setting for these patients. However, all patients with MPM can derive benefit from immunotherapy treatments, and these agents should ultimately be used at some point during their treatment journey. There are ongoing studies in the frontline unresectable setting that may further define the frontline therapy space, but a critical area of research will need to focus on the immunotherapy refractory population. This review article will describe the new developments in the areas of biology with genomics and chromothripsis, and also focus on updates in treatment strategies in radiology, surgery, radiation, and medical oncology with cellular therapies. These recent innovations are generating momentum to find better therapies for this disease.
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Affiliation(s)
- Anne S. Tsao
- The University of Texas MD Anderson Cancer Center, Department of Thoracic & Head and Neck Medical Oncology, Houston, TX,Anne S. Tsao, MD, MBA, University of Texas MD Anderson Cancer Center, Department of Thoracic/Head and Neck Medical Oncology, 1515 Holcombe Blvd, Unit 432, Houston, TX 77030; e-mail:
| | - Harvey I. Pass
- NYU Langone Medical Center, Department of Cardiothoracic Surgery, New York, NY
| | - Andreas Rimner
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY
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15
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Breda C, Furia S, Lucchini G, Zaccaria A, Verderi E, Natale G, Lo Giudice F, Cavallin R, Ferronato A, Fontana P. Long-term outcomes after lung-sparing surgery for epithelial mesothelioma. J Thorac Dis 2022; 13:6283-6293. [PMID: 34992808 PMCID: PMC8662484 DOI: 10.21037/jtd-21-691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/13/2021] [Indexed: 11/06/2022]
Abstract
Background This observational study evaluates retrospectively the long-term outcomes after pleurectomy/decortication for pleural mesothelioma, with and without the resection/reconstruction of diaphragm and pericardium. Methods Data from 155 consecutive patients undergoing lung-sparing surgery for epithelial pleural mesothelioma were reviewed. Selection criteria for surgery were cT1-3, cN0-1, good performance status, age <80 years. Perioperative Pemetrexed-Platinum regimen was administered as induction in 101 cases (65.2%) and as adjuvant treatment in 54 cases (34.8%). Extended pleurectomy/decortication was performed in 87 cases (56.12%). In 68 patients (43.87%) standard pleurectomy/decortication was performed without resection/reconstruction of diaphragm and pericardium, when tumour infiltration was deemed absent after intraoperative frozen section. The log-rank test and Cox regression model were used to assess the factors affecting overall survival and recurrence free survival. Results Median follow-up was 20 months. The 2- and 5-year survival rate was 60.9% and 29.2% with a median survival of 34 months. An improved survival was observed when standard pleurectomy/decortication was carried out (P=0.007). A significant impact on survival was found comparing the TNM-stages (P=0.001), pT (P=0.002) and pN variables (P=0.001). Multivariate analysis identified the pN-status (P=0.003) and standard pleurectomy/decortication (P=0.017) as predictive for longer survival. The recurrence-free survival >12 months was strongly related to the overall survival (P<0.001). The macroscopic complete resection (P=0.001), TNM-stage (P=0.003) and pT-status (P=0.001) are related to relapse. Conclusions Within multimodal management of pleural mesothelioma, lung-sparing surgery is a valid option even with more conservative technique. A benefit for a longer survival was observed in the early stage of disease, with pN0 and when pleurectomy/decortication is carried out, preserving diaphragm and pericardium. Recurrence is not affected by the type of surgery, and a recurrence-free interval >12 months is predictive of an increased survival when the macroscopic complete resection is achieved.
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Affiliation(s)
- Cristiano Breda
- Thoracic Surgery Unit, Ospedale dell'Angelo, Venezia Mestre, Italy
| | - Simone Furia
- Thoracic Surgery Unit, Ospedale dell'Angelo, Venezia Mestre, Italy
| | - Giuseppe Lucchini
- Department Healthcare Medical Management, Biostatistic Service, ASST Mantova, Mantova, Italy
| | - Antonio Zaccaria
- Thoracic Surgery Unit, Ospedale dell'Angelo, Venezia Mestre, Italy
| | - Enrico Verderi
- Thoracic Surgery Unit, Ospedale dell'Angelo, Venezia Mestre, Italy
| | - Giuseppe Natale
- Thoracic Surgery Unit, Ospedale dell'Angelo, Venezia Mestre, Italy
| | - Fabio Lo Giudice
- Thoracic Surgery Unit, Ospedale dell'Angelo, Venezia Mestre, Italy
| | - Roberta Cavallin
- Thoracic Surgery Unit, Ospedale dell'Angelo, Venezia Mestre, Italy
| | - Andrea Ferronato
- Thoracic Surgery Unit, Ospedale dell'Angelo, Venezia Mestre, Italy
| | - Paolo Fontana
- Thoracic Surgery Unit, Ospedale dell'Angelo, Venezia Mestre, Italy
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16
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Klotz LV, Gruenewald C, Bulut EL, Eichhorn F, Thomas M, Shah R, Kriegsmann M, Schmidt W, Kofler O, Winter H, Eichhorn ME. Cytoreductive Thoracic Surgery Combined with Hyperthermic Chemoperfusion for Pleural Malignancies: A Single-Center Experience. Respiration 2021; 100:1165-1173. [PMID: 34384085 DOI: 10.1159/000517334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lung-sparing cytoreductive surgery by extended pleurectomy and decortication (EPD) in combination with hyperthermic intrathoracic chemoperfusion (HITOC) forms a promising treatment strategy for malignant pleural mesothelioma and recurrent pleural thymic malignancies. OBJECTIVES The objective of this study was to scrutinize the surgical procedure and perioperative patient management with emphasis on perioperative morbidity and local tumor control. METHODS In 2014, a standardized EPD and HITOC procedure was implemented at the Thoraxklinik Heidelberg. This retrospective analysis included clinical data of consecutive patients with pleural mesothelioma and pleural metastasized malignancies treated by EPD and HITOC. The surgical procedure, perioperative management, lung function data, and progression-free survival (PFS) were analyzed. RESULTS In the time range between April 2, 2014 and July 2018, 76 patients with pleural malignancies have been treated with EPD and HITOC, and were analyzed retrospectively. It included 61 patients with pleural mesothelioma and 15 patients with pleural metastases of thymic malignancies (12), non-small cell lung cancer (1), colorectal carcinoma (1), and sarcoma (1). Perioperative morbidity following EPD and HITOC treatments represented 23.7% of overall malignancies, while 30- and 90-day mortality were 0 and 1.3%, respectively. Median PFS lasted 18.4 months for mesothelioma and 72.2 months for thymic malignancies. CONCLUSION Combining EPD with HITOC can be performed in patients with either pleural mesothelioma or pleural metastases resulting in low perioperative morbidity and mortality as well as remarkable local tumor control.
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Affiliation(s)
- Laura V Klotz
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Division of Molecular Thoracic Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christiane Gruenewald
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Elena L Bulut
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Florian Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Thomas
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Thoracic Oncology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Rajiv Shah
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Thoracic Oncology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Mark Kriegsmann
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Werner Schmidt
- Department of Anaesthesiology and Intensive Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Othmar Kofler
- Department of Anaesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Hauke Winter
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Martin E Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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17
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Hasegawa S, Yokoi K, Okada M, Tanaka F, Shimokawa M, Daimon T, Nakano T. Neoadjuvant pemetrexed plus cisplatin followed by pleurectomy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2021; 163:1940-1947.e5. [PMID: 34419248 DOI: 10.1016/j.jtcvs.2021.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/12/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Despite becoming the preferred surgical technique for malignant pleural mesothelioma, pleurectomy/decortication has received few prospective clinical trials. Therefore, the Japan Mesothelioma Interest Group conducted a prospective multi-institutional study to evaluate the feasibility of neoadjuvant chemotherapy followed by pleurectomy/decortication. METHODS Patients with histologically confirmed, resectable malignant pleural mesothelioma underwent neoadjuvant chemotherapy comprising pemetrexed 500 mg/m2 plus cisplatin 75 mg/m2 for 3 cycles, followed by pleurectomy/decortication. The primary end point was macroscopic complete resection rate regardless of the surgical technique used. RESULTS Among the 24 patients enrolled, 20 received neoadjuvant chemotherapy and 18 proceeded to surgery, all of whom achieved macroscopic complete resection. Pleurectomy/decortication was performed in 15 patients. The trial satisfied the primary end point, with a macroscopic complete resection rate of 90% (18/20, 95% confidence interval, 68.3-98.8). No treatment-related 30- and 90-day mortality occurred. The overall survival after 1 and 2 years and median overall survival after registration were 95.0% (95% confidence interval, 69.5-99.3), 70.0% (95% confidence interval, 45.1-85.3), and 3.45 years (95% confidence interval, 1.64 to not available), respectively. The cumulative incidence of progression after 1 and 2 years and median time to progression were 33.3% (95% confidence interval, 17.3-64.1), 61.1% (95% confidence interval, 42.3-88.3), and 1.71 years (95% confidence interval, 1.00-2.99), respectively. The best postoperative value for forced expiratory volume was 78.0% of preoperative values. CONCLUSIONS Neoadjuvant chemotherapy followed by pleurectomy/decortication was feasible with acceptable survival and mortality/morbidity. Postoperative pulmonary function was approximately 80% of the preoperative pulmonary function.
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Affiliation(s)
- Seiki Hasegawa
- Division of Thoracic Surgery, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube-shi, Yamaguchi, Japan
| | - Takashi Daimon
- Department of Biostatistics, Hyogo College of Medicine, Nishinomiya, Japan
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18
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Waller DA, Opitz I, Bueno R, Van Schil P, Cardillo G, Harpole D, Adusumilli PS, De Perrot M. Divided by an ocean of water but united in an ocean of uncertainty: A transatlantic review of mesothelioma surgery guidelines. J Thorac Cardiovasc Surg 2021; 161:1922-1925. [PMID: 33223192 DOI: 10.1016/j.jtcvs.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- David A Waller
- Barts Thorax Centre, St Bartholomew's Hospital, London, United Kingdom.
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital/Antwerp University, Antwerp, Belgium
| | - Giuseppe Cardillo
- Department of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - David Harpole
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Marc De Perrot
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada; (i)Division of Thoracic Surgery, Department of Immunology, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
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19
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Waller DA, Opitz I, Bueno R, Van Schil P, Cardillo G, Harpole D, Adusumilli PS, De Perrot M. Divided by an ocean of water but united in an ocean of uncertainty: a transatlantic review of mesothelioma surgery guidelines. Eur J Cardiothorac Surg 2021; 59:8-11. [PMID: 33395697 DOI: 10.1093/ejcts/ezaa363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- David A Waller
- Barts Thorax Centre, St Bartholomew's Hospital, London, UK
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital/Antwerp University, Antwerp, Belgium
| | - Giuseppe Cardillo
- Department of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - David Harpole
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Marc De Perrot
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto General Hospital, Toronto, ON, Canada.,Division of Thoracic Surgery, Department of Immunology, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
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20
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Gray SG. Emerging avenues in immunotherapy for the management of malignant pleural mesothelioma. BMC Pulm Med 2021; 21:148. [PMID: 33952230 PMCID: PMC8097826 DOI: 10.1186/s12890-021-01513-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/25/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The role of immunotherapy in cancer is now well-established, and therapeutic options such as checkpoint inhibitors are increasingly being approved in many cancers such as non-small cell lung cancer (NSCLC). Malignant pleural mesothelioma (MPM) is a rare orphan disease associated with prior exposure to asbestos, with a dismal prognosis. Evidence from clinical trials of checkpoint inhibitors in this rare disease, suggest that such therapies may play a role as a treatment option for a proportion of patients with this cancer. MAIN TEXT While the majority of studies currently focus on the established checkpoint inhibitors (CTLA4 and PD1/PDL1), there are many other potential checkpoints that could also be targeted. In this review I provide a synopsis of current clinical trials of immunotherapies in MPM, explore potential candidate new avenues that may become future targets for immunotherapy and discuss aspects of immunotherapy that may affect the clinical outcomes of such therapies in this cancer. CONCLUSIONS The current situation regarding checkpoint inhibitors in the management of MPM whilst encouraging, despite impressive durable responses, immune checkpoint inhibitors do not provide a long-term benefit to the majority of patients with cancer. Additional studies are therefore required to further delineate and improve our understanding of both checkpoint inhibitors and the immune system in MPM. Moreover, many new potential checkpoints have yet to be studied for their therapeutic potential in MPM. All these plus the existing checkpoint inhibitors will require the development of new biomarkers for patient stratification, response and also for predicting or monitoring the emergence of resistance to these agents in MPM patients. Other potential therapeutic avenues such CAR-T therapy or treatments like oncolytic viruses or agents that target the interferon pathway designed to recruit more immune cells to the tumor also hold great promise in this hard to treat cancer.
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Affiliation(s)
- Steven G Gray
- Thoracic Oncology Research Group, Central Pathology Laboratory, CPL 30, TCDSJ Cancer Institute, St James's Hospital, Dublin, D08 RX0X, Ireland.
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.
- School of Biology, Technical University of Dublin, Dublin, Ireland.
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21
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Ripley RT, Palivela N. Extended pleurectomy and decortication: Video atlas of operative steps. JTCVS Tech 2021; 7:324-330. [PMID: 34318281 PMCID: PMC8312143 DOI: 10.1016/j.xjtc.2021.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/10/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Nihanth Palivela
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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22
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Nakamura A, Hashimoto M, Matsumoto S, Kondo N, Kijima T, Hasegawa S. Outcomes of Conversion to Extrapleural Pneumonectomy From Pleurectomy/Decortication for Malignant Pleural Mesothelioma. Semin Thorac Cardiovasc Surg 2021; 33:873-881. [PMID: 33609685 DOI: 10.1053/j.semtcvs.2021.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Abstract
In recent years, there has been a shift from extrapleural pneumonectomy (EPP) toward pleurectomy/decortication (P/D) as the preferred surgical technique. However, we occasionally encounter difficult cases wherein visceral pleurectomy requires conversion to EPP from P/D. We sought to clarify the preoperative risk factors and clinical outcomes associated with conversion to EPP. We compared and analyzed conversion to EPP and P/D between September 2012 and December 2019. Conversion to EPP was decided in case of diffuse tumor invasion to the pulmonary parenchyma or due to failure of decortication. Univariable regression analysis was performed to determine the association of preoperative variables with conversion to EPP. Survival was analyzed by the Kaplan-Meier method and log-rank test. Of the 181 patients who underwent intended P/D, 145 (80.1%) patients underwent P/D and 18 (9.9%) patients underwent conversion to EPP. The sum of 3-level pleural thickness (P < 0.001), maximum of 3-level pleural thickness (P = 0.006), and clinical T stage (P < 0.001) demonstrated association with conversion to EPP. Overall survival and progression-free survival were significantly worse in the conversion to EPP group (median overall survival, 29.2 months vs 57.0 months [P = 0.008]; median progression-free survival, 15.3 months vs 23.2 months [P = 0.005]. Our data show that approximately 1 of every 10 patients with P/D intention converted to EPP. Preoperative pleural thickness and clinical T stage may be risk factors associated with conversion to EPP. The survival rate of conversion to EPP was worse than that of P/D.
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Affiliation(s)
- Akifumi Nakamura
- Divisions of Thoracic Surgery and Respiratory Medicine, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan.
| | - Masaki Hashimoto
- Divisions of Thoracic Surgery and Respiratory Medicine, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Seiji Matsumoto
- Divisions of Thoracic Surgery and Respiratory Medicine, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Nobuyuki Kondo
- Divisions of Thoracic Surgery and Respiratory Medicine, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Takashi Kijima
- Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Seiki Hasegawa
- Divisions of Thoracic Surgery and Respiratory Medicine, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
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Abstract
Despite multiple diagnostic toolkits, the diagnosis of diffuse malignant pleural mesothelioma relies primarily on proper histologic assessment. The definitive diagnosis of diffuse malignant pleural mesothelioma is based on the pathologic assessment of tumor tissue, which can be obtained from core biopsy sampling, pleurectomy, or other more extensive resections, such as extrapleural pneumonectomy. Given its rarity and overlapping microscopic features with other conditions, the histologic diagnosis of diffuse malignant pleural mesothelioma is challenging. This review discusses the pathologic features and the differential diagnosis of diffuse malignant pleural mesothelioma, including select diagnostic pitfalls.
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Affiliation(s)
- Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Lucian R Chirieac
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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24
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Cho BCJ, Donahoe L, Bradbury PA, Leighl N, Keshavjee S, Hope A, Pal P, Cabanero M, Czarnecka K, McRae K, Tsao MS, de Perrot M. Surgery for malignant pleural mesothelioma after radiotherapy (SMART): final results from a single-centre, phase 2 trial. Lancet Oncol 2021; 22:190-197. [PMID: 33450184 DOI: 10.1016/s1470-2045(20)30606-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND A novel approach for managing malignant pleural mesothelioma, surgery for mesothelioma after radiotherapy (SMART), consisting of a short accelerated course of high-dose, hemithoracic, intensity modulated radiotherapy (IMRT) followed by extrapleural pneumonectomy was developed. The aim of this study was to evaluate the clinical feasibility of the SMART protocol. METHODS In this single-centre, phase 2 trial, patients aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0-2, with histologically proven, resectable, cT1-3N0M0 disease who had previously untreated malignant pleural mesothelioma were eligible for inclusion. Patients received 25 Gy in five daily fractions over 1 week to the entire ipsilateral hemithorax with a concomitant 5 Gy boost to high risk areas followed by extrapleural pneumonectomy within 1 week. Adjuvant chemotherapy was offered to patients with ypN+ disease on final pathology. The primary endpoint was feasibility, which was defined as the number of patients with 30-day perioperative treatment-related death (grade 5 events) or morbidity (grade 3 or 4 events). A key secondary endpoint was cumulative incidence of distant recurrence. The final analysis was done on an intention-to-treat basis (including all eligible patients). This trial is registered with ClinicalTrials.gov, NCT00797719. FINDINGS Between Nov 1, 2008, and Oct 31, 2019, 102 patients were enrolled onto the trial and 96 eligible patients were treated with SMART on protocol and included in the analysis. Extrapleural pneumonectomy was done at a median of 5 days (range 2-12) after completing IMRT. 47 (49%) patients had 30-day perioperative grade 3-4 events and one (1%) patient died within 30 days perioperatively (grade 5 event; pneumonia). After a median follow-up of 46·8 months (IQR 13·4-61·2), the 5-year cumulative incidence of distant recurrence was 62 (63·3% [95% CI 52·3-74·4]). The most common first sites of recurrence were the contralateral chest (33 [46%] of 72 patients) and the peritoneal cavity (32 [44%]). INTERPRETATION Results from this study suggest that extrapleural pneumonectomy after radiotherapy can be done with good early and long-term results. However, minimising grade 4 events on the protocol is technically demanding and might affect survival beyond the post-operative period. FUNDING Princess Margaret Hospital Foundation Mesothelioma Research Fund.
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Affiliation(s)
- B C John Cho
- Department of Radiation Oncology, University Health Network, University of Toronto, ON, Canada.
| | - Laura Donahoe
- Princess Margaret Cancer Centre, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada
| | - Penelope A Bradbury
- Division of Medical Oncology, University Health Network, University of Toronto, ON, Canada
| | - Natasha Leighl
- Division of Medical Oncology, University Health Network, University of Toronto, ON, Canada
| | - Shaf Keshavjee
- Princess Margaret Cancer Centre, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada
| | - Andrew Hope
- Department of Radiation Oncology, University Health Network, University of Toronto, ON, Canada
| | - Prodipto Pal
- Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, ON, Canada
| | - Michael Cabanero
- Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, ON, Canada
| | - Kasia Czarnecka
- Princess Margaret Cancer Centre, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada; Division of Respirology, Department of Medicine, University Health Network, University of Toronto, ON, Canada
| | - Karen McRae
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, ON, Canada
| | - Ming-Sound Tsao
- Department of Pathology, Laboratory Medicine Program, University Health Network, University of Toronto, ON, Canada
| | - Marc de Perrot
- Princess Margaret Cancer Centre, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada
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25
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ZHAO M, ZHAN Q. Rehabilitation treatment of enteral nutrition whey protein in lung cancer patients in southern China. FOOD SCIENCE AND TECHNOLOGY 2021. [DOI: 10.1590/fst.22620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | - Qingqing ZHAN
- Taizhou Vocational College of Science and Technology, China
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26
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Ripley RT, Palivela N, Groth SS, Choi EA, Cornwell LD, Carrott PW, Van Buren G, Splawn TG, Sugarbaker DJ, Burt BM. Diagnostic Laparoscopy Improves Staging of Malignant Pleural Mesothelioma With Routine Positron Emission Tomography Imaging. Ann Thorac Surg 2020; 112:1568-1574. [PMID: 33275932 DOI: 10.1016/j.athoracsur.2020.08.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 07/08/2020] [Accepted: 08/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND With a multimodal treatment strategy, cytoreductive surgery extends survival in malignant pleural mesothelioma. Improving the accuracy of staging can refine patient selection. Our objective was to determine whether diagnostic laparoscopy (DL) improves staging for patients with malignant pleural mesothelioma with the routine use of positron emission tomography (PET). METHODS We performed a retrospective review of our prospectively maintained database from February 2014 to May 2019. Inclusion criteria were patients who had disease in the chest that was deemed potentially resectable by radiographic criteria and who underwent DL as part of the staging evaluation before surgery. RESULTS Of 187 patients (71% men, 80% epithelial) who underwent DL during staging, 76% proceeded to surgery; 22% were unresectable at exploratory thoracotomy and 78% underwent resection (pleurectomy and decortication, 68%; extrapleural pneumonectomy, 32%). Also, 89% had a PET computed tomography (CT), and 11% had a preoperative CT without PET. DL revealed peritoneal disease in 17%. Among patients with pathologically proven disease at DL, 77% had negative PET-CT imaging. Based on the pathologic findings at DL the sensitivity, specificity, positive predictive value, and negative predictive value of PET-CT were 23%, 78%, 17%, and 83%, respectively. The accuracy of PET-CT was 68%. CONCLUSIONS PET-CT has low sensitivity and diagnostic accuracy to identify peritoneal disease in malignant pleural mesothelioma. DL as part of the preoperative staging defines an important subset of patients with bicavitary disease. We recommend DL as a component of staging before surgery.
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Affiliation(s)
- R Taylor Ripley
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
| | - Nihanth Palivela
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Shawn S Groth
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Eugene A Choi
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Lorraine D Cornwell
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Philip W Carrott
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - George Van Buren
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Taylor G Splawn
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - David J Sugarbaker
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Bryan M Burt
- The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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27
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Ghirardelli P, Franceschini D, D'Aveni A, Dominici L, Ravasio A, Marzo M, Villa E, Di Noia V, Scorsetti M, Vavassori V, Ceresoli GL. Salvage radiotherapy for oligo-progressive malignant pleural mesothelioma. Lung Cancer 2020; 152:1-6. [PMID: 33310300 DOI: 10.1016/j.lungcan.2020.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/18/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES No standard treatment option is available for patients with unresectable malignant pleural mesothelioma (MPM) progressing after upfront chemotherapy. We aimed to explore the role of focal radiotherapy (FRT) as a treatment modality for oligo-progressive MPM. MATERIALS AND METHODS In this retrospective study, consecutive patients pretreated with ≥1 lines of chemotherapy were included. Oligo-progressive MPM was defined as an unresectable disease with radiological progression at ≤3 sites according to a chest-abdominal contrast-enhanced computed tomography. Patients were treated with either stereotactic body radiotherapy (SBRT, ≥5 Gy per fraction) or hypo-fractionated radiotherapy (hypoRT, <5 Gy per fraction). Time to further systemic therapy (TFST) and local control (LC) after FRT were the primary endpoints. Biologically effective dose (BED) was calculated using three different alpha/beta models (1.5 Gy, 3 Gy and 10 Gy). RESULTS From April 2006 to March 2019, 37 patients were treated on 43 pleural lesions; 16/37 (43 %) had undergone upfront multimodality treatment (MMT) including surgery. FRT was given in 22/37 (59.5 %) after one line of chemotherapy. SBRT was delivered for 26/43 lesions (60.5 %), hypoRT for 17/43 (39.5 %). Median TFST was 6 months (95 % CI 4.9-7.1). LC at 6 months and 1 year was 84 % and 76 %, respectively. Median TFST was longer in patients treated after 1 vs >1 line of chemotherapy (9 vs 4 months, p = 0.001) and in patients pretreated with MMT (6 vs 3 months, p = 0.021). Six-month LC was better in patients treated with a BED > 100 using alpha/beta 1.5 and 3. No ≥ G3 acute or late toxicities were reported. CONCLUSION FRT was feasible in selected patients with oligo-progressive MPM, allowing delay of further systemic therapies, with no severe toxicity. FRT was more effective when performed at progression after one line of systemic therapy. Our results suggest a radio-resistant behavior of MPM.
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Affiliation(s)
- Paolo Ghirardelli
- Department of Radiotherapy, Cliniche Humanitas Gavazzeni, Via Gavazzeni 21, 24125, Bergamo, Italy
| | - Davide Franceschini
- Department of Radiotherapy, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alessandro D'Aveni
- Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Via Gavazzeni 21, 24125 Bergamo, Italy
| | - Luca Dominici
- Department of Radiotherapy, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Andrea Ravasio
- Department of Radiotherapy, Cliniche Humanitas Gavazzeni, Via Gavazzeni 21, 24125, Bergamo, Italy
| | - Marco Marzo
- Department of Radiotherapy, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Elisa Villa
- Department of Radiotherapy, Cliniche Humanitas Gavazzeni, Via Gavazzeni 21, 24125, Bergamo, Italy
| | - Vincenzo Di Noia
- Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Via Gavazzeni 21, 24125 Bergamo, Italy
| | - Marta Scorsetti
- Department of Radiotherapy, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Vittorio Vavassori
- Department of Radiotherapy, Cliniche Humanitas Gavazzeni, Via Gavazzeni 21, 24125, Bergamo, Italy
| | - Giovanni L Ceresoli
- Department of Medical Oncology, Cliniche Humanitas Gavazzeni, Via Gavazzeni 21, 24125 Bergamo, Italy.
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28
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Waller DA, Opitz I, Bueno R, Van Schil P, Cardillo G, Harpole D, Adusumilli PS, De Perrot M. Divided by an Ocean of Water but United in an Ocean of Uncertainty: A Transatlantic Review of Mesothelioma Surgery Guidelines. Ann Thorac Surg 2020; 111:386-389. [PMID: 33223138 DOI: 10.1016/j.athoracsur.2020.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 11/15/2022]
Affiliation(s)
- David A Waller
- Barts Thorax Centre, St Bartholomew's Hospital, London, United Kingdom.
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital/Antwerp University, Antwerp, Belgium
| | - Giuseppe Cardillo
- Department of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - David Harpole
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Marc De Perrot
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada; Division of Thoracic Surgery, Department of Immunology, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
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29
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Donahoe LL, de Perrot M. The Role of Extrapleural Pneumonectomy in Malignant Pleural Mesothelioma. Thorac Surg Clin 2020; 30:461-471. [DOI: 10.1016/j.thorsurg.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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30
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Abstract
Extended pleurectomy and decortication (ePD) is a difficult operation performed for the surgical resection of malignant pleural mesothelioma that can achieve a macroscopic complete resection with preservation of the lung. With lower perioperative mortality, similar long-term survival, and better tolerance in patients with lower performance status, ePD has become the preferred operation rather than extrapleural pneumonectomy despite lack of a direct comparison. As ePD has become more popular, international collaboration is underway to create surgical guidelines based on collection of operative data. These efforts will improve the safety and standardization of this operation.
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Affiliation(s)
- R Taylor Ripley
- Department of Surgery, Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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31
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Wolf AS, Flores RM. Updates in Staging and Management of Malignant Pleural Mesothelioma. Surg Oncol Clin N Am 2020; 29:603-612. [PMID: 32883461 DOI: 10.1016/j.soc.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
While without treatment, malignant pleural mesothelioma (MPM) confers poor survival, cancer-directed surgery as part of multimodality treatment is associated with a 15% 5-year survival. Extrapleural pneumonectomy (EPP) and radical or extended pleurectomy/decortication (P/D) are the 2 types of resection performed in this context. Preoperative staging is critical to patient selection for surgery; P/D is recommended over EPP in most cases. Adjuvant therapy with intraoperative platforms, traditional chemotherapy, hemithoracic radiotherapy resection, and new immunotherapy agents are instrumental in achieving durable long-term results. We outline the latest understanding of disease staging and describe the current state of literature and practice.
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Affiliation(s)
- Andrea S Wolf
- Department of Thoracic Surgery, The Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, Box 1023, New York, NY 10029, USA.
| | - Raja M Flores
- Department of Thoracic Surgery, The Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, Box 1023, New York, NY 10029, USA
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32
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Astoul P. Rethought histologic classification of pleural mesothelioma to better treat: go forward from looking back. Transl Lung Cancer Res 2020; 9:1613-1616. [PMID: 32953534 PMCID: PMC7481632 DOI: 10.21037/tlcr-20-592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology - Aix-Marseille University, Marseille, France
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33
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Standardizing Surgical Treatment of Malignant Pleural Mesothelioma. J Thorac Oncol 2020; 15:e73-e74. [PMID: 32340681 DOI: 10.1016/j.jtho.2019.12.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 11/23/2022]
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34
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Reply to Waller et al. Standardizing Surgical Treatment for Mesothelioma. J Thorac Oncol 2020; 15:e75-e77. [PMID: 32340682 DOI: 10.1016/j.jtho.2020.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/23/2020] [Indexed: 11/22/2022]
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35
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Giles AE, Kidane B. Commentary: Know your enemy-Understanding futility in the battle against malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2020; 159:2523-2524. [PMID: 32122574 DOI: 10.1016/j.jtcvs.2020.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 01/05/2020] [Accepted: 01/05/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Andrew E Giles
- Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Research Institute in Oncology & Hematology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada.
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36
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Gray SG, Mutti L. Immunotherapy for mesothelioma: a critical review of current clinical trials and future perspectives. Transl Lung Cancer Res 2020; 9:S100-S119. [PMID: 32206576 PMCID: PMC7082257 DOI: 10.21037/tlcr.2019.11.23] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
At the clinical level the role of immunotherapy in cancer is currently at a pivotal point. Therapies such as checkpoint inhibitors are being approved at many levels in cancers such as non-small cell lung cancer (NSCLC). Mesothelioma is a rare orphan disease associated with prior exposure to asbestos, with a dismal prognosis. Various clinical trials for checkpoint inhibitors have been conducted in this rare disease, and suggest that such therapies may play a role as a treatment option for a proportion of patients with this cancer. Most recently approved as a salvage therapy in mesothelioma was granted in Japan, regulatory approval for their use in the clinic elsewhere lags. In this article we review the current pertinent clinical trials of immunotherapies in malignant mesothelioma, discuss the current issues that may affect the clinical outcomes of such therapies and further evaluate potential candidate new avenues that may become future targets for immunotherapy in this cancer.
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Affiliation(s)
- Steven G Gray
- Thoracic Oncology Research Group, Trinity St. James's Cancer Institute, Trinity Translational Medicine Institute, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland
| | - Luciano Mutti
- Center for Biotechnology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA, USA
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37
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Commentary: Biphasic malignant mesothelioma-Survival of the fittest. J Thorac Cardiovasc Surg 2019; 159:1596-1597. [PMID: 31619328 DOI: 10.1016/j.jtcvs.2019.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022]
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