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Lapidot M, Sattler M. The Role of Surgery in Pleural Mesothelioma. Cancers (Basel) 2024; 16:1719. [PMID: 38730667 PMCID: PMC11083222 DOI: 10.3390/cancers16091719] [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: 03/27/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Surgery plays a central role in the diagnosis, staging, and management of pleural mesothelioma. Achieving an accurate diagnosis through surgical intervention and identifying the specific histologic subtype is crucial for determining the appropriate course of treatment. The histologic subtype guides decisions regarding the use of chemotherapy, immunotherapy, or multimodality treatment. The goal of surgery as part of multimodality treatment is to accomplish macroscopic complete resection with the eradication of grossly visible and palpable disease. Over the past two decades, many medical centers worldwide have shifted from performing extra-pleural pneumonectomy (EPP) to pleurectomy decortication (PD). This transition is motivated by the lower rates of short-term mortality and morbidity associated with PD and similar or even better long-term survival outcomes, compared to EPP. This review aims to outline the role of surgery in diagnosing, staging, and treating patients with pleural mesothelioma.
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Affiliation(s)
- Moshe Lapidot
- Division of Thoracic Surgery, Lung Center and International Mesothelioma Program, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
- Department of Thoracic Surgery, Galilee Medical Center, Nahariya 2210001, Israel
| | - Martin Sattler
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA;
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2
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Iser S, Hintermair S, Varga A, Çelik A, Sayan M, Kankoç A, Akyürek N, Öğüt B, Bertoglio P, Capozzi E, Solli P, Ventura L, Waller D, Weber M, Stubenberger E, Ghanim B. Validation of Inflammatory Prognostic Biomarkers in Pleural Mesothelioma. Cancers (Basel) 2023; 16:93. [PMID: 38201520 PMCID: PMC10778470 DOI: 10.3390/cancers16010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/16/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Evoked from asbestos-induced inflammation, pleural mesothelioma represents a fatal diagnosis. Therapy ranges from nihilism to aggressive multimodality regimens. However, it is still unclear who ultimately benefits from which treatment. We aimed to re-challenge inflammatory-related biomarkers' prognostic value in times of modern immune-oncology and lung-sparing surgery. The biomarkers (leukocytes, hemoglobin, platelets, neutrophils, lymphocytes, monocytes, neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), C-reactive protein (CRP)) and clinical characteristics (age, sex, histology, therapy) of 98 PM patients were correlated to overall survival (OS). The median OS was 19.4 months. Significant OS advantages (Log-Rank) were observed in multimodal treatment vs. others (26.1 vs. 7.2 months, p < 0.001), surgery (pleurectomy/decortication) vs. no surgery (25.5 vs. 3.8 months, p < 0.001), a high hemoglobin level (cut-off 12 g/dL, 15 vs. 24.2 months, p = 0.021), a low platelet count (cut-off 280 G/L, 26.1 vs. 11.7 months, p < 0.001), and a low PLR (cut-off 194.5, 25.5 vs. 12.3 months, p = 0.023). Histology (epithelioid vs. non-epithelioid, p = 0.002), surgery (p = 0.004), CRP (cut-off 1 mg/dL, p = 0.039), and platelets (p = 0.025) were identified as independent prognostic variables for this cohort in multivariate analysis (Cox regression, covariates: age, sex, histology, stage, CRP, platelets). Our data verified the previously shown prognostic role of systemic inflammatory parameters in patients treated with lung-sparing surgery within multimodality therapy.
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Affiliation(s)
- Stephanie Iser
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
| | - Sarah Hintermair
- Department of General and Thoracic Surgery, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
| | - Alexander Varga
- Department of Pathology, University Hospital Krems, 3500 Krems, Austria
| | - Ali Çelik
- Department of Thoracic Surgery, School of Medicine, Gazi University, Besevler, 06500 Ankara, Turkey
| | - Muhammet Sayan
- Department of Thoracic Surgery, School of Medicine, Gazi University, Besevler, 06500 Ankara, Turkey
| | - Aykut Kankoç
- Department of Thoracic Surgery, School of Medicine, Gazi University, Besevler, 06500 Ankara, Turkey
| | - Nalan Akyürek
- Department of Pathology, School of Medicine, Gazi University, Besevler, 06500 Ankara, Turkey
| | - Betül Öğüt
- Department of Pathology, School of Medicine, Gazi University, Besevler, 06500 Ankara, Turkey
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Enrico Capozzi
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Piergiorgio Solli
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Luigi Ventura
- Barts Thorax Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BS, UK
- Department of Thoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - David Waller
- Barts Thorax Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BS, UK
| | - Michael Weber
- Division of Biostatistics and Data Science, Department of General Health Studies, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
| | - Elisabeth Stubenberger
- Department of General and Thoracic Surgery, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
| | - Bahil Ghanim
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Austria
- Department of General and Thoracic Surgery, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
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3
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Sun H, Kim MM, Ong YH, Dimoft A, Singhal S, Busch TM, Cengel KA, Zhu TC. Evaluation of Detector Position and Light Fluence Distribution Using an Infrared Navigation System during Pleural Photodynamic Therapy †. Photochem Photobiol 2023; 99:814-825. [PMID: 35996976 PMCID: PMC9947188 DOI: 10.1111/php.13697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022]
Abstract
Photodynamic therapy (PDT) has been used to treat malignant pleural mesothelioma. Current practice involves delivering light to a prescribed light fluence with a point source, monitored by eight isotropic detectors inside the pleural cavity. An infrared (IR) navigation system was used to track the location of the point source throughout the treatment. The recorded data were used to reconstruct the pleural cavity and calculate the light fluence to the whole cavity. An automatic algorithm was developed recently to calculate the detector positions based on recorded data within an hour. This algorithm was applied to patient case studies and the calculated results were compared to the measured positions, with an average difference of 2.5 cm. Calculated light fluence at calculated positions were compared to measured values. The differences between the calculated and measured light fluence were within 14% for all cases, with a fixed scattering constant and a dual correction method. Fluence-surface histogram (FSH) was calculated for photofrin-mediated PDT to be able to cover 80% of pleural surface area to 50 J cm-2 (83.3% of 60 J cm-2 ). The study demonstrates that it will be possible to eliminate the manual measurement of the detector positions, reducing the patient's time under anesthesia.
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Affiliation(s)
- Hongjing Sun
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Michele M Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Yi Hong Ong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Andreea Dimoft
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Sunil Singhal
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Theresa M. Busch
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Keith A Cengel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States of America
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Shah R, Klotz LV, Glade J. Current Management and Future Perspective in Pleural Mesothelioma. Cancers (Basel) 2022; 14:1044. [PMID: 35205798 PMCID: PMC8869935 DOI: 10.3390/cancers14041044] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 11/16/2022] Open
Abstract
Pleural mesothelioma is an aggressive malignancy arising from pleural mesothelial cell lining, predominantly associated with prior exposure to asbestos. The ban on asbestos use has led to its lower incidence in many countries, but globally the disease burden is expected to rise. Therefore, well-planned research is needed to develop more effective, tolerable and affordable drugs. The development of novel treatment has been too slow, with only two regimens of systemic therapy with robust phase 3 data approved formally to date. The treatment scenario for resectable disease remains controversial. However, recent developments in the understanding of disease and clinical trials have been encouraging, and may add better treatment options in the coming years. In this review, we discuss the current treatment options for pleural mesothelioma and shed light on some recent studies and ongoing trials.
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Affiliation(s)
- Rajiv Shah
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital, 69126 Heidelberg, Germany
| | - Laura V. Klotz
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, 69126 Heidelberg, Germany;
| | - Julia Glade
- Institute for Pathology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
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Brims F. Epidemiology and Clinical Aspects of Malignant Pleural Mesothelioma. Cancers (Basel) 2021; 13:cancers13164194. [PMID: 34439349 PMCID: PMC8391310 DOI: 10.3390/cancers13164194] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/12/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023] Open
Abstract
Mesothelioma is a cancer predominantly of the pleural cavity. There is a clear association of exposure to asbestos with a dose dependent risk of mesothelioma. The incidence of mesothelioma in different countries reflect the historical patterns of commercial asbestos utilisation in the last century and predominant occupational exposures mean that mesothelioma is mostly seen in males. Modern imaging techniques and advances in immunohistochemical staining have contributed to an improved diagnosis of mesothelioma. There have also been recent advances in immune checkpoint inhibition, however, mesothelioma remains very challenging to manage, especially considering its limited response to conventional systemic anticancer therapy and that no cure exists. Palliative interventions and support remain paramount with a median survival of 9-12 months after diagnosis. The epidemiology and diagnosis of mesothelioma has been debated over previous decades, due to a number of factors, such as the long latent period following asbestos exposure and disease occurrence, the different potencies of the various forms of asbestos used commercially, the occurrence of mesothelioma in the peritoneal cavity and its heterogeneous pathological and cytological appearances. This review will describe the contemporary knowledge on the epidemiology of mesothelioma and provide an overview of the best clinical practice including diagnostic approaches and management.
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Affiliation(s)
- Fraser Brims
- Curtin Medical School, Curtin University, Perth, WA 6845, Australia;
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA 6009, Australia
- National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Perth, WA 6009, Australia
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Gu R, Jiang L, Duan T, Chen C, Wu S, Mu D. A Case of Pulmonary Embolism with Sarcomatoid Malignant Pleural Mesothelioma with Long-Term Pleural Effusion. Onco Targets Ther 2021; 14:4231-4237. [PMID: 34295165 PMCID: PMC8291962 DOI: 10.2147/ott.s315869] [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: 04/20/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is a highly aggressive tumor that originates from pleural mesothelial cells. In recent years, with the development of asbestos-related industries and the increase in air pollution, its incidence has been increased. The incidence of pulmonary embolism combined with sarcomatoid MPM is very low and the prognosis is extremely poor. We here report a case of a patient with long term of pleural effusion and finally diagnosed as pulmonary embolism with sarcomatoid MPM. Case A 75-year-old male with a 30-year history of asbestos exposure was admitted to our hospital due to chest pain and difficulty in breathing after exercise. Radiologic examination revealed pleural effusion, computed tomography pulmonary angiography (CTPA) suggests pulmonary embolism, and we consider pleural effusion caused by pulmonary embolism. After anticoagulant therapy for pulmonary embolism and pleural puncture to reduce pleural effusion, the patient's symptoms improved. However, after that, the patient was still admitted to the hospital several times because of recurrent chest pain and dyspnea symptoms, and radiologic examination always showed unexplained pleural effusion. Finally, pathological and immunohistochemical examinations of the pleural biopsy specimens were performed, and the diagnosis was confirmed as sarcomatoid MPM. Conclusion In summary, sarcomatoid MPM with pulmonary embolism is relatively rare, and the prognosis is poor. Clinicians need to be alert to its occurrence. When the first diagnosis is confirmed and the effect of targeted treatment is still not good, the possibility of other diseases should be considered. In clinical practice, pleural biopsy guided by PET-CT is a good choice for patients with sarcomatoid MPM who cannot tolerate open pleural biopsies or thoracoscopy. And patients should undergo pleural morphology and immunohistochemistry as soon as possible, which are helpful for timely diagnosis.
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Affiliation(s)
- Rumeng Gu
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China.,Graduate School of Clinical Medicine, Bengbu Medical College, Bengbu, People's Republic of China
| | - Luxi Jiang
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
| | - Ting Duan
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
| | - Chun Chen
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
| | - Shengchang Wu
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
| | - Deguang Mu
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People's Republic of China
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Surgical Management and Reconstruction of Diaphragm, Pericardium and Chest Wall in Mesothelioma Surgery: A Review. J Clin Med 2021; 10:jcm10112330. [PMID: 34073544 PMCID: PMC8197912 DOI: 10.3390/jcm10112330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022] Open
Abstract
Mesothelioma is an aggressive disease arising from parietal pleura. Surgery is a valuable option in the frame of a multimodality treatment. Several surgical approaches have been standardized with the aim of a macroscopic complete resection; these often require homolateral diaphragm and pericardial resection and reconstruction. Extrapleural pneumonectomy (EPP) and extended pleurectomy decortication (EPD) have been recognized as radical surgical procedures. Nevertheless, both operations are technically challenging and associated with a significant rate of peri-operative morbidity and non-negligible mortality. The diaphragmatic and pericardial reconstruction technique is mandatory to avoid respiratory impairment and to reduce post-operative complications like gastric and cardiac herniation. Moreover, in the case of localized chest wall recurrence, surgery might be considered a valuable therapeutical option for highly selected and fit patients. All the technical aspects of the resection and reconstruction of the diaphragm, pericardium, and chest wall are described as well as the possible use of new minimally invasive techniques. In addition, the choice of different prosthetic materials, considering the most recent innovations in the field, are discussed.
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Bilancia R, Nardini M, Waller DA. Extended pleurectomy decortication: the current role. Transl Lung Cancer Res 2018; 7:556-561. [PMID: 30450294 DOI: 10.21037/tlcr.2018.06.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Extended pleurectomy/decortication (EPD) has been formally defined but there remain technical areas of debate between practitioners. This is partly attributable to the relative rarity of this operation which is largely confined to a small number of specialist centres. Nevertheless, there is a widespread acceptance that extended pleurectomy/decortication (P/D) is a realistic and favourable alternative to extrapleural pneumonectomy. There may, however, remain a small number of clinical cases where this more extensive operation may be indicated. Preservation of the lung has widened the selection criteria for this form of radical mesothelioma surgery but there remain important factors to consider when offering extended P/D. In many patients with poorer prognostic factors the less radical operation of video assisted partial pleurectomy may be preferable. However, a randomized trial showed no survival benefit for this operation over simple talc pleurodesis. The future for P/D may also lie in the outcome of the MARS2 randomized controlled trial which will report in the next few years. Meanwhile there is a clinical and ethical dilemma when asked to perform this operation outside of the context of a clinical trial in the face of the lack of high grade evidence. The role of P/D is in one respect expanding but this may be short lived pending the findings of its assessment against non-surgical treatment.
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Affiliation(s)
- Rocco Bilancia
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Marco Nardini
- Department of Thoracic Surgery, University Hospital of Catania, Catania, Italy
| | - David A Waller
- Department of Thoracic Surgery, St Bartholomew's Hospital, London, UK
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Bueno R, Opitz I. Surgery in Malignant Pleural Mesothelioma. J Thorac Oncol 2018; 13:1638-1654. [DOI: 10.1016/j.jtho.2018.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 01/05/2023]
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10
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Benítez JC, Campayo M, Call S, Bastús R. Malignant Pleural Mesothelioma: The Last 8 Years of Experience in Our Area. Arch Bronconeumol 2018; 54:637-638. [PMID: 29804950 DOI: 10.1016/j.arbres.2018.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/14/2018] [Accepted: 03/16/2018] [Indexed: 11/29/2022]
Affiliation(s)
- José Carlos Benítez
- Servicio de Oncología Médica, Hospital Universitari Mútua de Terrassa, Universidad de Barcelona, Terrassa, Barcelona, España
| | - Marc Campayo
- Servicio de Oncología Médica, Hospital Universitari Mútua de Terrassa, Universidad de Barcelona, Terrassa, Barcelona, España
| | - Sergi Call
- Servicio de Cirugía Torácica, Hospital Universitari Mútua de Terrassa, Universidad de Barcelona, Terrassa, Barcelona, España
| | - Romà Bastús
- Servicio de Oncología Médica, Hospital Universitari Mútua de Terrassa, Universidad de Barcelona, Terrassa, Barcelona, España.
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Abdel‐Rahman O, Elsayed Z, Mohamed H, Eltobgy M. Radical multimodality therapy for malignant pleural mesothelioma. Cochrane Database Syst Rev 2018; 1:CD012605. [PMID: 29309720 PMCID: PMC6491325 DOI: 10.1002/14651858.cd012605.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma is an almost always fatal tumour, for which palliative platinum-based chemotherapy is currently the standard treatment. Multimodal therapeutic strategies incorporating surgery, radiation therapy or photodynamic therapy and chemotherapy have been recommended for selected patients but there is no consensus about their effectiveness. OBJECTIVES To assess the benefits and harms of radical multimodal treatment options (including radical surgery ± radical radiotherapy ± photodynamic therapy ± systemic therapy) compared to each other or to palliative treatments, for people with malignant pleural mesothelioma. SEARCH METHODS We reviewed data from the Cochrane Lung Cancer group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase. We also checked reference lists of primary original studies, review articles and relevant conference proceedings manually for further related articles up to 21 March 2017. SELECTION CRITERIA We included parallel-group randomised controlled trials of multimodal therapy for people with malignant pleural mesothelioma (stages I, II or III) that measured at least one of the following endpoints: overall survival, health-related health-related quality of life, adverse events or progression-free survival. We considered studies regardless of language or publication status. DATA COLLECTION AND ANALYSIS Two review authors independently extracted relevant information on participant characteristics, interventions, study outcomes, and data on the outcomes for this review, as well as information on the design and methodology of the studies. Two review authors assessed the risk of bias in the included trials using pre-defined 'Risk of bias' domains. We assessed the methodological quality using GRADE. MAIN RESULTS We conducted this review in accordance with the published Cochrane protocol. Two randomised clinical trials with 104 participants fulfilled our inclusion criteria. Both trials were at high risk of bias (for outcomes other than overall survival), and we rated the evidence as moderate quality for overall survival and low quality for all other outcomes. One trial compared combined extrapleural pneumonectomy (EPP) plus neoadjuvant platinum-based chemotherapy plus postoperative high-dose hemithoracic radiotherapy with combined EPP plus platinum-based chemotherapy. The other trial compared EPP plus postoperative hemithoracic radiotherapy with standard (non-radical) therapy alone following platinum-based chemotherapy (patients in the standard therapy arm received continued oncological management according to local policy, which could include further chemotherapy or palliative radiotherapy).For the first trial, median overall survival calculated from registration was 20.8 months (95% confidence interval (CI) 14.4 to 27.8) in the no-radiotherapy group and 19.3 months (95% CI 11.5 to 21.8) in the radiotherapy group. For the second trial, median overall survival was 14.4 months (95% CI 5.3 to 18.7) for patients allocated to EPP and 19.5 months (95% CI 13.4 to time not yet reached) for patients randomised to standard non-radical therapy. In the second trial, 12 serious adverse events were reported during the study period: ten in the EPP group and two in the non-radical therapy group. Overall health-related quality of life scores were not different between the two arms in either study. We could not perform a meta-analysis of the two included trials due to clinical heterogeneity. We also identified three ongoing trials evaluating the topic of our review. AUTHORS' CONCLUSIONS The overall strength of the evidence gathered in this review is low and there is a lack of available evidence to support the use of radical multimodality therapy in routine clinical practice (particularly as one trial suggests greater harm). Given the added cost of multimodality treatment and the possible increase in risk of adverse effects, the lack of evidence of their effectiveness probably means that these interventions should currently be limited to clinical trials alone.
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Affiliation(s)
- Omar Abdel‐Rahman
- Faculty of Medicine, Ain Shams UniversityClinical OncologyLofty Elsayed StreetCairoEgypt11335
| | - Zeinab Elsayed
- Faculty of Medicine, Ain Shams UniversityClinical OncologyLofty Elsayed StreetCairoEgypt11335
| | - Hadeer Mohamed
- Faculty of Medicine, Ain Shams UniversityEl methaq Street, Madinet NasrCairoEgypt11371
| | - Mostafa Eltobgy
- Faculty of Medicine, Ain Shams UniversityEl methaq Street, Madinet NasrCairoEgypt11371
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12
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Ricciardi S, Cardillo G, Zirafa CC, Carleo F, Facciolo F, Fontanini G, Mutti L, Melfi F. Surgery for malignant pleural mesothelioma: an international guidelines review. J Thorac Dis 2018; 10:S285-S292. [PMID: 29507797 DOI: 10.21037/jtd.2017.10.16] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Currently there is no universally accepted surgical therapy for malignant pleural mesothelioma (MPM). The goal of surgery in this dismal disease is a macroscopic complete resection (MCR) and there are two types of intervention with a curative intent. At one side, there is the extrapleural pneumonectomy (EPP) which consists in an en-bloc resection of the lung, pleura, pericardium and diaphragm and at the other side, there is pleurectomy/decortication (P/D) a lung-sparing surgery. Initially, EPP was considered the only surgical option with a curative aim, but during the decades P/D have acquired a role of increasing importance in MPM therapy. Several randomized prospective trials are required to establish the best strategy in the treatment of pleural mesothelioma. Although which is the best surgical option remains unclear, the International Mesothelioma Interest Group (IMIG), recently have stated that the type of surgery depends on clinical factors and on individual surgical judgment and expertise. Moreover, according to the current evidence, the surgery should be performed in high-volume centres within multimodality protocols. The aim of this study is to examine the currently available international guidelines in the surgical diagnosis and treatment of MPM.
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Affiliation(s)
- Sara Ricciardi
- Unit of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Carmelina Cristina Zirafa
- Robotic Multispeciality Center of Surgery Robotic and Minimally Invasive Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Francesco Carleo
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | - Luciano Mutti
- Biomedical Research Center, University of Salford, Manchester, UK
| | - Franca Melfi
- Robotic Multispeciality Center of Surgery Robotic and Minimally Invasive Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
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13
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Bertoglio P, Aprile V, Ambrogi MC, Mussi A, Lucchi M. The role of intracavitary therapies in the treatment of malignant pleural mesothelioma. J Thorac Dis 2018; 10:S293-S297. [PMID: 29507798 DOI: 10.21037/jtd.2017.10.165] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Surgery is one of the steps of multimodality approach for the treatment of MPM. Due to anatomical features, microscopically radical (R0) resection is never possible and a Macroscopic Complete Resection (R1) is considered the target for mesothelioma surgeons. Recently, intracavitary therapies have been described with the aim of extending the loco-regional effect of surgery. Different agents might be administered intrapleurally: chemotherapy drugs are the most widely used, but also photodynamic therapy (PDT) showed to lead to satisfactory long-term outcomes; furthermore, immunotherapies and gene therapies have been also reported. Despite promising results, no high-quality evidences are currently available and controlled randomized trials are required to establish the exact role of intracavitary therapies and to standardize the technique.
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Affiliation(s)
- Pietro Bertoglio
- Division of Thoracic Surgery, Sacro Cuore Don Calabria Research Hospital and Cancer Care Centre, Negrar, Verona, Italy
| | - Vittorio Aprile
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular pathology and Critical Area, University Hospital of Pisa, via Paradisa 2 56100 Pisa (PI), Italy
| | - Marcello Carlo Ambrogi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular pathology and Critical Area, University Hospital of Pisa, via Paradisa 2 56100 Pisa (PI), Italy
| | - Alfredo Mussi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular pathology and Critical Area, University Hospital of Pisa, via Paradisa 2 56100 Pisa (PI), Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular pathology and Critical Area, University Hospital of Pisa, via Paradisa 2 56100 Pisa (PI), Italy
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Cherrie JW, McElvenny D, Blyth KG. Estimating past inhalation exposure to asbestos: A tool for risk attribution and disease screening. Int J Hyg Environ Health 2018; 221:27-32. [DOI: 10.1016/j.ijheh.2017.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/26/2017] [Accepted: 09/29/2017] [Indexed: 12/17/2022]
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15
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Ambrogi MC, Bertoglio P, Aprile V, Chella A, Korasidis S, Fontanini G, Fanucchi O, Lucchi M, Mussi A. Diaphragm and lung-preserving surgery with hyperthermic chemotherapy for malignant pleural mesothelioma: A 10-year experience. J Thorac Cardiovasc Surg 2017; 155:1857-1866.e2. [PMID: 29191688 DOI: 10.1016/j.jtcvs.2017.10.070] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 09/24/2017] [Accepted: 10/12/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The best surgical treatment for malignant pleural mesothelioma is still under a debate, but recent evidence points toward a less-invasive approach to reduce morbidity and mortality. We reported our 10-year experience of a limited surgical approach associated with hyperthermic intrathoracic chemotherapy (HITHOC). MATERIAL AND METHODS Between 2005 and 2014, patients with epithelioid or biphasic malignant pleural mesothelioma were treated with lung-diaphragm-pericardium-sparing pleurectomy associated with double-drug HITHOC; at least 3 cycles of adjuvant chemotherapy were then administered. The primary outcome examined was the feasibility of the procedure, whereas secondary outcomes were overall survival and disease-free interval. RESULTS Among 49 patients, 41 were male. Median age was 68 years (35-76 years). Histology was epithelioid in 43 cases. Pathologic stage I, II, III, and IV occurred in 12, 14, 20, and 3 cases, respectively. No intraoperative complications or postoperative mortality occurred, whereas morbidity rate was 46.9%. Median hospital stay was 8 days (5-45 days). Actuarial median overall survival was 22 months and a 1-, 2-, and 5-year survival accounted for 79.6%, 45.7%, and 9.9%, respectively. Disease-free survival after surgery was 62%, 37.5%, and 18.5% at 1, 2, and 5 years, respectively. Risk factors analysis for overall survival confirmed a significant role for early stages, epithelioid histology, and fibrinogen serum levels. CONCLUSIONS Cytoreductive surgery associated with HITHOC and adjuvant chemotherapy appears feasible and safe, with no mortality and low morbidity. Preserving lung and diaphragmatic function might warrant an acceptable long-term outcome.
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Affiliation(s)
- Marcello Carlo Ambrogi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Pietro Bertoglio
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy.
| | - Vittorio Aprile
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Antonio Chella
- Division of Pneumonology, Cardio Vascular and Thoracic Department, University Hospital of Pisa, Pisa, Italy
| | - Stylianos Korasidis
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Gabriella Fontanini
- Division of Pathological Anatomy, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Olivia Fanucchi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
| | - Alfredo Mussi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University Hospital of Pisa, Pisa, Italy
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16
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Opitz I, Weder W. A nuanced view of extrapleural pneumonectomy for malignant pleural mesothelioma. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:237. [PMID: 28706905 DOI: 10.21037/atm.2017.03.88] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Multimodality treatment including macroscopic complete resection (MCR) is currently the most effective therapy for patients with malignant pleural mesothelioma (MPM). However, the allocation to one of the possible combinations has to be discussed individually since various factors influence the decision making process. In the past years, relevant new information about the disease and the outcome of different treatment modalities have been generated, which allows a more individual allocation to the best treatment. For many years extrapleural pneumonectomy (EPP)-the most aggressive procedure to achieve a MCR-was the first choice in combination with adjuvant or neo-adjuvant chemotherapy and radiation therapy for all patients except those with minimal disease. However, mortality and morbidity of an EPP and the fact, that even with the most radical procedure only MCR and not a complete resection can be achieved, led to shift towards pleurectomy/decortication in most of the centers. But also today, EPP is still a valuable option in selected cases and the entire treatment concept requires a nuanced view, which will be discussed in this review.
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Affiliation(s)
- Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zürich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zürich, Switzerland
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17
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Goričar K, Kovač V, Dolžan V. Clinical-pharmacogenetic models for personalized cancer treatment: application to malignant mesothelioma. Sci Rep 2017; 7:46537. [PMID: 28422153 PMCID: PMC5396189 DOI: 10.1038/srep46537] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 03/22/2017] [Indexed: 12/29/2022] Open
Abstract
Large interindividual differences in treatment outcome are observed in cancer patients undergoing chemotherapy. Our aim was to develop and validate clinical-pharmacogenetic prediction models of gemcitabine/cisplatin or pemetrexed/cisplatin treatment outcome and develop an algorithm for genotype-based treatment recommendations in malignant mesothelioma (MM). We genotyped 189 MM patients for polymorphisms in gemcitabine, pemetrexed and cisplatin metabolism, transport and drug target genes and DNA repair pathways. To build respective clinical-pharmacogenetic models, pharmacogenetic scores were assigned by rounding regression coefficients. Gemcitabine/cisplatin model was based on training group of 71 patients and included CRP, histological type, performance status, RRM1 rs1042927, ERCC2 rs13181, ERCC1 rs3212986, and XRCC1 rs25487. Patients with higher score had shorter progression-free (PFS) and overall survival (P < 0.001). This model’s sensitivity was 0.615 and specificity 0.812. In independent validation group of 66 patients the sensitivity and specificity were 0.667 and 0.641, respectively. Pemetrexed/cisplatin model was based on 57 patients and included CRP, MTHFD1 rs2236225, and ABCC2 rs2273697. Patients with higher score had worse response and shorter PFS (P < 0.001). This model’s sensitivity was 0.750 and specificity 0.607. In independent validation group of 20 patients the sensitivity and specificity were 0.889 and 0.500, respectively. The proposed algorithm based on these models could enable the choice of the most effective chemotherapy for 85.5% of patients and lead to improved treatment outcome in MM.
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Affiliation(s)
- Katja Goričar
- Pharmacogenetics Laboratory, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Viljem Kovač
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Vita Dolžan
- Pharmacogenetics Laboratory, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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18
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Abdel-Rahman O, Elsayed Z, Mohamed H, Eltobgy M. Radical multimodality therapy for malignant pleural mesothelioma. Hippokratia 2017. [DOI: 10.1002/14651858.cd012605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Omar Abdel-Rahman
- Faculty of Medicine, Ain Shams University; Clinical Oncology; Lofty Elsayed Street Cairo Egypt 11335
| | - Zeinab Elsayed
- Faculty of Medicine, Ain Shams University; Clinical Oncology; Lofty Elsayed Street Cairo Egypt 11335
| | - Hadeer Mohamed
- Faculty of Medicine, Ain Shams University; El methaq Street, Madinet Nasr Cairo Egypt 11371
| | - Mostafa Eltobgy
- Faculty of Medicine, Ain Shams University; El methaq Street, Madinet Nasr Cairo Egypt 11371
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Bertoglio P, Ambrogi MC, Chella A, Aprile V, Dini P, Korasidis S, Fanucchi O, Mussi A. Is less also better? A single-institution experience on treatment of early stage Malignant Pleural Mesothelioma. Eur J Surg Oncol 2017; 43:1365-1371. [PMID: 28274663 DOI: 10.1016/j.ejso.2017.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 01/07/2017] [Accepted: 02/12/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES No clear evidence of which surgical procedure should be performed for early stage mesothelioma is available to date. We analyzed our 10-year experience in the treatment of early stage mesothelioma with surgery and Hyperthermic IntraTHOracic Chemotherapy. METHODS We retrospectively analyzed all cases of histologically proven epithelioid or biphasic IMIG stage I and II mesothelioma that we operated between 2005 and 2014. We performed an open pleurectomy and partial decortication of any visible lesion on the visceral pleura in all cases and both diaphragm and pericardium were always spared; Hyperthermic IntraTHOracic Chemotherapy was ran using Cisplatin 80 mg/m2 and Doxorubicin 25 mg/m2 at a target temperature of 42.5 °C for 60 min. RESULTS We operated on 26 patients (23 male and 3 female); epithelioid tumor was diagnosed in 23 cases. Twelve patients were in IMIG stage I and 14 in IMIG stage II; median overall survival for all patients, stage I and II were 35.6, 46 and 23 months respectively and disease free survival was 18, 18 and 16 months respectively. Our results for stage I were better than those reported in literature and were similar for stage II. We observe no 30- and 90- mortality and the rate of severe complication (all CTCAE stage 3) were 30%; the median postoperative stay was 7.5 days. CONCLUSIONS Our lung sparing approach for the treatment of pleural mesothelioma in early stages allows promising long term outcomes with a complete sparing of pulmonary and diaphragmatic function. Larger studies are needed to confirm our good results.
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Affiliation(s)
- P Bertoglio
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy.
| | - M C Ambrogi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy
| | - A Chella
- Division of Pneumology, Cardio Thoracic and Vascular Department, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy
| | - V Aprile
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy
| | - P Dini
- Division of Thoracic Surgery, Cardio Thoracic and Vascular Department, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy
| | - S Korasidis
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy
| | - O Fanucchi
- Division of Thoracic Surgery, Cardio Thoracic and Vascular Department, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy
| | - A Mussi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University Hospital of Pisa, via Paradisa 2, 56100 Pisa, PI, Italy
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20
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Bertoglio P, Fanucchi O, Ricciardi S, Chella A, Lucchi M, Mussi A. Chest wall resection for mesothelioma recurrence after surgery. Asian Cardiovasc Thorac Ann 2016; 24:893-895. [PMID: 27926466 DOI: 10.1177/0218492316674861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Malignant pleural mesothelioma is an aggressive and usually fatal disease, and its optimal management is still under debate. Surgery for recurrent malignant mesothelioma has been reported rarely in highly selected cases. We report a case of chest wall resection for local recurrence of epithelioid mesothelioma 3 years after cytoreductive surgery. Our patient experienced a 6-month disease-free survival after redo surgery, with complete resolution of his chest pain and discomfort.
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Affiliation(s)
- Pietro Bertoglio
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Olivia Fanucchi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Sara Ricciardi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Antonio Chella
- Division of Pneumonology, University Hospital of Pisa, Pisa, Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Alfredo Mussi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
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