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Szczyrek M, Bitkowska P, Jutrzenka M, Szudy-Szczyrek A, Drelich-Zbroja A, Milanowski J. Pleural Neoplasms-What Could MRI Change? Cancers (Basel) 2023; 15:3261. [PMID: 37370871 DOI: 10.3390/cancers15123261] [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: 04/06/2023] [Revised: 05/16/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
The primary pleural neoplasms constitute around 10% of the pleural tumors. The currently recommended method for their imaging is CT which has been shown to have certain limitations. Strong development of the MRI within the last two decades has provided us with a number of sequences that could potentially be superior to CT when it comes to the pleural malignancies' detection and characterization. This literature review discusses the possible applications of the MRI as a diagnostic tool in patients with pleural neoplasms. Although selected MRI techniques have been shown to have a number of advantages over CT, further research is required in order to confirm the obtained results, broaden our knowledge on the topic, and pinpoint the sequences most optimal for pleural imaging, as well as the best methods for reading and analysis of the obtained data.
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Affiliation(s)
- Michał Szczyrek
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Paulina Bitkowska
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Marta Jutrzenka
- Collegium Medicum, University of Warmia and Mazury in Olsztyn, Aleja Warszawska 30, 11-041 Olsztyn, Poland
| | - Aneta Szudy-Szczyrek
- Department of Haematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-090 Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Radiology and Neuroradiology, Medical University of Lublin, 20-954 Lublin, Poland
| | - Janusz Milanowski
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland
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Cangemi M, Montico M, Trovo M, Minatel E, Di Gregorio E, Corona G, Giordari F, Comaro E, Colizzi F, Baboçi L, Steffan A, Revelant A, Muraro E. Emerging Role of Immunomonitoring to Predict the Clinical Outcome of Patients With Malignant Pleural Mesothelioma Treated With Radical Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 115:608-621. [PMID: 36202181 DOI: 10.1016/j.ijrobp.2022.09.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 09/16/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The present study aimed at evaluating the baseline immune profile and the immunomodulating effects of radical hemithoracic radiation therapy (RT) in patients affected by malignant pleural mesothelioma (MPM) to identify potential predictive biomarkers of therapy response, toxicity development, and eligibility for further immunotherapeutic treatments. METHODS AND MATERIALS Blood samples were collected from 55 patients with MPM, enrolled in a phase 3 trial comparing radical hemithoracic RT (interventional arm, n = 28) with local palliative RT (control arm, n = 27). Immunomonitoring was performed before RT, at the end of treatment, and 1 month after therapy, characterizing natural killer cells, B and T lymphocytes, activated CD4 and CD8 T cells, interferon-γ- and tumor necrosis factor-α-producing T helper (Th) 1 cells, regulatory T cells, and Th17 and Th22 lymphocytes, through flow cytometry. Serum levels of interleukin (IL)-6, -8, -10 and mesothelin were quantified through Enzyme-Linked Immunosorbent Assay (ELISA) assays at the same time points. Variations in the immune parameters were investigated by Friedman test and Wilcoxon signed rank post hoc test with Bonferroni correction for multiple testing, while the prognostic effect of immune biomarkers was evaluated through Kaplan-Meier method and Spearman's correlation analysis. RESULTS Major immune variations were noticed after radical RT compared with palliative treatment, in particular an improvement in activated T cells and in interferon-γ-producing Th1 cells after RT. In the interventional arm, baseline high levels of Th22 and IL-10 and an increase in T cells were associated with an improved survival, whereas a fold increase in serum mesothelin correlated with the development of severe toxicity. An improvement of immunosuppressive regulatory T cells was observed in both arms of treatment. CONCLUSIONS The immunomonitoring performed in patients with MPM revealed potential prognostic biomarkers for radical hemithoracic RT treatment and identified specific immune signatures induced by RT immunomodulation, which could suggest a synergistic effect with an immunotherapeutic treatment.
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Affiliation(s)
- Michela Cangemi
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Marcella Montico
- Clinical Trial Office, Scientific Direction, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Marco Trovo
- Department of Radiation Oncology, Udine General Hospital, Udine, Italy
| | - Emilio Minatel
- Division of Radiation Oncology, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Emanuela Di Gregorio
- Immunopathology and Cancer Biomarkers, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Giuseppe Corona
- Immunopathology and Cancer Biomarkers, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Fabiana Giordari
- Immunopathology and Cancer Biomarkers, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Elisa Comaro
- Immunopathology and Cancer Biomarkers, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Francesca Colizzi
- Immunopathology and Cancer Biomarkers, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Lorena Baboçi
- Immunopathology and Cancer Biomarkers, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Agostino Steffan
- Immunopathology and Cancer Biomarkers, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Alberto Revelant
- Division of Radiation Oncology, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Elena Muraro
- Immunopathology and Cancer Biomarkers, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy.
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Ma GY, Shi S, Sang YZ, Wang P, Zhang ZG. High Expression of SMO and GLI1 Genes with Poor Prognosis in Malignant Mesothelioma. BIOMED RESEARCH INTERNATIONAL 2023; 2023:6575194. [PMID: 37139482 PMCID: PMC10151145 DOI: 10.1155/2023/6575194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 01/10/2023] [Accepted: 02/07/2023] [Indexed: 05/05/2023]
Abstract
Background To investigate the value of SMO and GLI1 genes in the hedgehog pathway in malignant mesothelioma specimens. Further study on the expression and prognosis of SMO and GLI1 in malignant mesothelioma tissues and the relationship between the two and the molecular mechanisms of mesothelioma immunity and to further investigate the prognostic value of mesothelioma expression. Materials and Methods Immunohistochemistry and RT-qPCR were applied to detect the expression of SMO and GLI1 proteins and mRNA in biopsy specimens and plasma cavity effusion specimens from malignant mesothelioma (n = 130) and benign mesothelial tissues (n = 50) and to analyze the clinicopathological significance and survival risk factors of SMO and GLI1 protein expression in mesothelioma. The mechanisms of mesothelioma cell expression and immune cell infiltration were investigated using bioinformatics methods. Results SMO and GLI1 in mesothelioma tissues detected high concordance between the diagnostic results of mesothelioma biopsy specimens and plasma cavity effusion specimens. The expression levels of SMO and GLI1 protein and mRNA in mesothelioma tissues were higher than those in benign mesothelioma tissues. The expression levels of SMO and GLI1 protein were correlated with the age, site, and asbestos exposure history of patients with mesothelioma. The expression levels of SMO and GLI1 protein were correlated with the expressions of ki67 and p53 (P < 0.05). SMO and GLI1 gene expression levels were negatively correlated with good prognosis in mesothelioma patients (P < 0.05). Cox proportional risk model indicated that protein expressions of invasion, lymph node metastasis, distant metastasis, staging, and genes were independent prognostic factors of mesothelioma. The GEPIA database showed the overall survival rate and the disease-free survival rate of mesothelioma patients in the high SMO and GLI1 expression groups; the UALCAN database analysis showed lower SMO expression levels in mesothelioma patients with more pronounced TP53 mutations (P = 0.001); GLI1 gene expression levels were strongly correlated with lymph node metastasis in mesothelioma patients (P = 0.009). Timer database analysis showed that the mechanism of immune cell infiltration was closely related to SMO and GLI1 expression. The degree of immune cell infiltration was strongly correlated with the prognosis of mesothelioma patients (P < 0.05). Conclusion The expression levels of both SMO and GLI1 proteins were higher than those of normal mesothelial tissues, and the mRNA expression levels also changed in the same direction. SMO and GLI1 gene expressions in mesothelioma were negatively correlated with age, site of occurrence, and history of asbestos exposure. Positive expression of SMO and GLI1 was negatively correlated with patient survival. The Cox proportional risk model showed that gender, history of asbestos exposure, site of occurrence, SMO, and GLI1 were independent prognostic factors for mesothelioma. The mechanism of immune cell infiltration in mesothelioma is closely related to the gene expression of both and the survival prognosis of mesothelioma patients.
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Affiliation(s)
- Guan-Ying Ma
- Department of Clinical Pathology, Chengde Medical University, Chengde, Hebei 067000, China
| | - Shuai Shi
- Department of Pathology, Cangzhou People's Hospital, Cangzhou, Hebei 061000, China
| | - Yin-Zhou Sang
- Department of Pathology, Cangzhou People's Hospital, Cangzhou, Hebei 061000, China
| | - Ping Wang
- Department of Pathology, Cangzhou People's Hospital, Cangzhou, Hebei 061000, China
| | - Zhi-Gang Zhang
- Department of Pathology, Cangzhou People's Hospital, Cangzhou, Hebei 061000, China
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Idkedek M, Tahayneh KS, Abu-Akar F, Bakri IA. Case Report and Review of Literature: Familial Malignant Pleural Mesothelioma in a 39 Years Old Patient With an Inconclusive 18F-FDG PET/CT Result. Front Surg 2022; 9:819596. [PMID: 35360426 PMCID: PMC8963911 DOI: 10.3389/fsurg.2022.819596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare yet aggressive neoplasm that was linked only to asbestos exposure for decades, although familial clusters were diagnosed with MPM without a known history of asbestos exposure most likely due to genetic susceptibility. Here, we describe a case of familial malignant mesothelioma in a 39 years old patient with a confirmed BAP1 mutation in addition to a known family history with the same mutation. The patient presented with progressive shortness of breath and recurrent pleural effusions and diagnosis was made through biopsies taken during uniportal Video-Assisted Thoracoscopic Surgery. After the inconclusive result of 18F-FDG PET/CT scan, subxiphoid uniportal Video-Assisted Thoracoscopic Surgery left pleural and laparoscopic peritoneal biopsies were obtained for staging and evaluating contralateral lung and peritoneal cavity. Finally, two important educational values should be acquired from this case: genetic predisposition and BAP1 tumor suppressor gene mutation might affect the age of presentation and overall prognosis of the disease. Also, 18F-FDG PET/CT scan may not be the best modality for staging and confirming the diagnosis of malignant pleural mesothelioma.
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Affiliation(s)
- Mayar Idkedek
- Medical Research Club, Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Kareem S. Tahayneh
- Medical Research Club, Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Firas Abu-Akar
- Department of Cardiothoracic Surgery, Al-Makassed Charitable Society Hospital, Jerusalem, Palestine
- *Correspondence: Firas Abu-Akar
| | - Izzeddin A. Bakri
- Department of Pathology, Al-Makassed Charitable Society Hospital, Jerusalem, Palestine
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Brown LB, Corl F, Blackmon SH. Surgical staging and resection of malignant pleural mesothelioma. J Thorac Dis 2020; 12:7467-7480. [PMID: 33447434 PMCID: PMC7797813 DOI: 10.21037/jtd-19-2267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Lawrence B Brown
- Johns Hopkins Medicine, Department of Surgery, Baltimore, MD, USA
| | - Frank Corl
- Mayo Clinic, Department of Media Services, Medical Illustration, Rochester, MN, USA
| | - Shanda H Blackmon
- Mayo Clinic, Division of General Thoracic Surgery, Department of Surgery, Rochester, MN, USA
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Ahmadzada T, Cooper WA, Holmes M, Mahar A, Westman H, Gill AJ, Nordman I, Yip PY, Pal A, Zielinski R, Pavlakis N, Nagrial A, Daneshvar D, Brungs D, Karikios D, Aleksova V, Burn J, Asher R, Grau GE, Hosseini-Beheshti E, Reid G, Clarke S, Kao S. Retrospective Evaluation of the Use of Pembrolizumab in Malignant Mesothelioma in a Real-World Australian Population. JTO Clin Res Rep 2020; 1:100075. [PMID: 34589956 PMCID: PMC8474198 DOI: 10.1016/j.jtocrr.2020.100075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION We investigated the efficacy and toxicity of pembrolizumab in patients with mesothelioma from a real-world Australian population. We aimed to determine clinical factors and predictive biomarkers that could help select patients who are likely to benefit from pembrolizumab. METHOD Patients with mesothelioma who were treated with pembrolizumab as part of the Insurance and Care New South Wales compensation scheme were included. Clinical information was collected retrospectively. Tumor biomarkers such as programmed death-ligand 1 (PD-L1), BAP1, and CD3-positive (CD3+) tumor-infiltrating lymphocytes (TILs) were examined using archival formalin-fixed paraffin-embedded tumor samples. RESULTS A total of 98 patients were included with a median age of 70 years (range, 46-91 y); 92% were men; 76% had epithelioid subtype; 21% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0. Pembrolizumab was used as second-line or subsequent-line treatment in 94 patients and as first-line treatment in four patients. The overall response rate was 18%, and the disease control rate was 56%. The median progression-free survival (PFS) was 4.8 months (95% confidence interval: 3.6-6.2), and the median overall survival (OS) was 9.5 months (95% confidence interval: 6.6-13.7). Immune-related adverse events occurred in 27% of patients, of which nine (9%) were of grade 3 or higher. In the multivariable analysis, factors independently associated with longer PFS included baseline ECOG status of 0 (median PFS: 12 mo versus 4 mo, p < 0.01) and PD-L1 tumor proportion score of greater than or equal to 1% (median PFS: 6 mo versus 4 mo, p < 0.01). Baseline platelet count of less than or equal to 400 × 109/liter was independently associated with longer PFS and OS (median PFS: 6 mo versus 2 mo, p = 0.05; median OS: 10 mo versus 4 mo, p = 0.01), whereas lack of pretreatment dexamethasone was independently associated with OS but not PFS (median OS: 10 mo versus 3 mo, p = 0.01). The odds of response were higher for patients with baseline ECOG status of 0 (p = 0.02) and with greater than or equal to 5% CD3+ TILs in the tumor (p < 0.01). PD-L1 expression, BAP1 loss, and CD3+ TILs in the stroma were not significantly associated with the overall response rate. CONCLUSIONS Immunotherapy is a reasonable treatment option for patients with mesothelioma. Our results are comparable to other clinical trials investigating pembrolizumab in mesothelioma in terms of response. Good performance status assessment remains the most robust predictor for patient outcomes. CD3+ TILs in the tumor may help select patients that are likely to respond to pembrolizumab, whereas factors such as PD-L1 expression, baseline platelet count, and lack of pretreatment dexamethasone may help predict survival outcomes from pembrolizumab treatment.
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Affiliation(s)
- Tamkin Ahmadzada
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Wendy A. Cooper
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Mikaela Holmes
- Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Annabelle Mahar
- Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Helen Westman
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anthony J. Gill
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ina Nordman
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Po Yee Yip
- Department of Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Abhijit Pal
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Drug Development Unit, Royal Marsden Hospital, Sutton, United Kingdom
| | - Rob Zielinski
- Central West Cancer Care Centre, Orange Base Hospital, Orange, New South Wales, Australia
- School of Medicine, Western Sydney University, New South Wales, Australia
| | - Nick Pavlakis
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Adnan Nagrial
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Medical Oncology Department, Westmead Hospital, New South Wales, Australia
| | - Dariush Daneshvar
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology & Medical Research (ICPMR)–Westmead Hospital, Sydney, New South Wales, Australia
| | - Daniel Brungs
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
- Illawarra Cancer Centre, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Deme Karikios
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Nepean Cancer Care Centre, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Vesna Aleksova
- Asbestos Diseases Research Institute, Sydney, New South Wales, Australia
| | - Juliet Burn
- Anatomical Pathology, Douglass Hanly Moir Pathology, Sydney, New South Wales, Australia
| | - Rebecca Asher
- National Health and Medical Research Council Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Georges E. Grau
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Immunology Unit, Department of Pathology, School of Medical Sciences, The University of Sydney, Camperdown, New South Wales, Australia
- The Sydney Nano Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Elham Hosseini-Beheshti
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Immunology Unit, Department of Pathology, School of Medical Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - Glen Reid
- Department of Pathology, University of Otago, Dunedin, New Zealand
| | - Stephen Clarke
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Steven Kao
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Asbestos Diseases Research Institute, Sydney, New South Wales, Australia
- Department of Medical Oncology, Chris O’Brien Lifehouse, Sydney, New South Wales, Australia
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Diffusion-Weighted Imaging Can Differentiate between Malignant and Benign Pleural Diseases. Cancers (Basel) 2019; 11:cancers11060811. [PMID: 31212757 PMCID: PMC6627409 DOI: 10.3390/cancers11060811] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 12/12/2022] Open
Abstract
It is not clear whether magnetic resonance imaging (MRI) is useful for the assessment of pleural diseases. The aim of this study is to determine whether diffusion-weighted magnetic resonance imaging (DWI) can differentiate malignant pleural mesothelioma (MPM) from pleural dissemination of lung cancer, empyema or pleural effusion. The DWI was calibrated with the b value of 0 and 800 s/mm2. There were 11 MPMs (8 epithelioid and 3 biphasic), 10 pleural disseminations of lung cancer, 10 empyemas, and 12 pleural effusions. The apparent diffusion coefficient (ADC) of the pleural diseases was 1.22 ± 0.25 × 10−3 mm2/s in the MPMs, 1.31 ± 0.49 × 10−3 mm2/s in the pleural disseminations, 2.01 ± 0.45 × 10−3 mm2/s in the empyemas and 3.76 ± 0.62 × 10−3 mm2/s in the pleural effusions. The ADC of the MPMs and the pleural disseminations were significantly lower than the ADC of the empyemas and the pleural effusions. Concerning the diffusion pattern of DWI, all 11 MPMs showed strong continuous diffusion, 9 of 10 pleural disseminations showed strong scattered diffusion and 1 pleural dissemination showed strong continuous diffusion, all 10 empyemas showed weak continuous diffusion, and all 12 pleural effusions showed no decreased diffusion. DWI can evaluate pleural diseases morphologically and qualitatively, and thus differentiate between malignant and benign pleural diseases.
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Muralidhar V, Raghav P, Das P, Goel A. A case from India of pleural malignant mesothelioma probably due to domestic and environmental asbestos exposure: a posthumous report. BMJ Case Rep 2019; 12:12/3/e227882. [PMID: 30936339 DOI: 10.1136/bcr-2018-227882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
India is the largest consumer of asbestos in the world. There is no report from India of mesothelioma related to asbestos. The case is a 42-year-old man who died of pleural mesothelioma. He was exposed to asbestos domestically and from the environment since birth. Two of his close family members worked in a factory that used asbestos. The living quarter of the family was within the premises of the factory. Asbestos waste was strewn on the grounds surrounding the quarters. After decades of legal battles by workers and families exposed to asbestos, Indian courts have ordered remedial measures and compensation to people, who are exposed to asbestos at work and the environment. Mesothelioma, currently in epidemic proportions in the west where asbestos production was banned in the 1990s, could rise to alarming levels in the next decades in India if the legal remedial measures are not implemented soon.
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Affiliation(s)
| | - Pankaja Raghav
- Community Medicine, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
| | - Prianka Das
- Community Medicine, National Institute of Preventive and Social Medicine, Dhaka, Dhaka District, Bangladesh
| | - Akhil Goel
- Community Medicine, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
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Arrieta O, Escamilla-López I, Lyra-González I, Barrón F, Ramírez-Tirado LA, Vergara E, Corona-Cruz JF, Maldonado F, Jiménez-Fuentes E. Radical aggressive treatment among non-small cell lung cancer patients with malignant pleural effusion without extra-thoracic disease. J Thorac Dis 2019; 11:595-601. [PMID: 30963004 DOI: 10.21037/jtd.2019.01.36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Malignant pleural effusion (MPE) is an indicator of advanced disease (stage M1a) in patients with non-small cell lung cancer (NSCLC). Typically, these patients are candidates for palliative treatment. There is a lack of evidence about the radical surgical treatment in carcinomatous pleuritis with massive effusion. Here, we present data from a specific subset of patients with MPE treated with systemic therapy and aggressive surgical therapy. M1a NSCLC adenocarcinoma patients with MPE and without extra-thoracic disease were included. After receiving systemic therapy, all patients underwent surgical treatment, which included pneumonectomy or lobectomy, plus mediastinal dissection. Following surgery, patients received radiotherapy to thoracic wall and mediastinum. A total of six patients were analyzed. All patients had an Eastern Cooperative Oncology Group (ECOG) performance status ≤1, two patients harbored EGFR mutation and were treated with tyrosine kinase inhibitors (TKIs), the other four patients were treated with pemetrexed and platin as first-line treatment. Following systemic therapy, two patients had a pneumonectomy, four patients had a lobectomy plus pleurectomy performed. All patients continued with maintenance systemic therapy, and achieved complete responses, according to RECIST 1.1 criteria. The media progression-free survival (PFS) time was 15.9 months (95% CI: 15.6-55.5 months). At the last follow-up, all patients were still alive, with 4 of them without signs of macroscopic tumoral activity. The median overall survival (OS) was not reached. NSCLC patients with MPE without extra-thoracic disease could benefit from an aggressive surgical approach following standard of care systemic therapy. However, considering the low sample size of this study and the relatively low incidence of MPE without extra-thoracic disease, further prospective multi-center studies are necessary to evaluate aggressive surgery as a therapeutic option.
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Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Iván Lyra-González
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Feliciano Barrón
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Edgar Vergara
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Federico Maldonado
- Radio-Oncology Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Edgardo Jiménez-Fuentes
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.,Thoracic Surgery Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
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Cameron RB. Staging in the era of international databases: documented improvements with remaining challenges. J Thorac Dis 2018; 10:682-687. [PMID: 29607134 PMCID: PMC5864645 DOI: 10.21037/jtd.2018.01.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/03/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Robert B. Cameron
- Divisions of Thoracic Surgery and Surgical Oncology, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Division of Thoracic Surgery, Department of Surgery and Perioperative Care, West Los Angeles VA Medical Center, Los Angeles, CA, USA
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