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Diagnosis, Staging, and Surgical Treatment of Malignant Pleural Mesothelioma

  • Malignant Mesothelioma
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Opinion statement

The clinical presentation of malignant pleural mesothelioma (MPM) is nonspecific. The process to obtain the correct diagnosis can be challenging and requires a high index of suspicion. Once the diagnosis is made, there is no universally accepted standard of care and treatment decisions are strongly influenced by physician bias. Physicians who see few numbers of patients tend to treat based on symptoms alone by drainage of the pleural effusion and talc pleurodesis, while physicians at several tertiary referral centers tend to take an aggressive multimodality approach incorporating surgical resection, chemotherapy, and radiation. The primary goal of surgery in this setting is the resection of all gross disease. The choice of operation, extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D), depends on disease stage, pulmonary function, philosophy of the treating physician, and type of planned adjuvant therapy.

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References and Recommended Reading

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  1. Flores RM, Zakowski M, Venkatraman E, et al. Prognostic Factors in the treatment of malignant pleural mesothelioma (MPM) at a large tertiary referral center. J Thorac Oncol 2007; 2:957–965. doi:10.1097/JTO.0b013e31815608d9

    Article  PubMed  Google Scholar 

  2. Elmes PC, Simpson MJC: The clinical aspects of mesothelioma. QJM New Series 1976;45:427.

    CAS  Google Scholar 

  3. Ruffie R, et al: Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients. J Clin Oncol 1989; 7:1157.

    CAS  PubMed  Google Scholar 

  4. Heelan RT, et al: Malignant pleural mesothelioma: comparison of CT and MR imaging. AJR Am J Roentgenol 1999; 172(4):1039–1047.

    CAS  PubMed  Google Scholar 

  5. Pass HI, Temeck BK, Kranda K, et al. Preoperative tumor volume is associated with outcome in malignant pleural mesothelioma. J Thorac Cardiovasc Surg 1998;115:310–317. doi:10.1016/S0022-5223(98)70274-0

    Article  CAS  PubMed  Google Scholar 

  6. Flores RM, Akhurst T, Gonen M, et al. Positron emission tomography defines metastatic disease but not locoregional disease in patients with malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2003; 126(1):11–16. doi:10.1016/S0022-5223(03)00207-1

    Article  PubMed  Google Scholar 

  7. Flores RM, Akhurst T, Gonen M, et al. Positron emission tomography predicts survival in malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2006:132(4):763–768. doi:10.1016/j.jtcvs.2006.03.068

    Article  PubMed  Google Scholar 

  8. Boutin C, et al: Activity of intrapleural recombinant gamma-interferon inmalignant mesothelioma. Cancer 1991; 67(8):2033–2037. doi:10.1002/1097-0142(19910415)67:8<2033::AID-CNCR2820670804>3.0.CO;2-8

    Article  CAS  PubMed  Google Scholar 

  9. Boutin C, Viallat JR, Aelony Y: Practical Thoracoscopy. Berlin: Springer-Verlag, 1991b

    Google Scholar 

  10. Butchart E, Ashcroft T, Barnsley W, et al. Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura: experience with 29 patients. Thorax 1976;31:15-24.

    Article  CAS  PubMed  Google Scholar 

  11. Chahinian AP, et al: Diffuse malignant mesothelioma. Prospective evaluation of 69 patients. Ann Intern Med 1982;96:746.

    CAS  PubMed  Google Scholar 

  12. Sugarbaker DJ, Flores RM, Jaklitsch MT, et al. Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg 1999;117:54–65. doi:10.1016/S0022-5223(99)70469-1

    Article  CAS  PubMed  Google Scholar 

Retrospective study showing prolonged survival for epithelioid, node negative, and margin negative patients.

  1. Greene FL, Page DL, Fleming ID, et al.: Pleural mesothelioma. In AJCC Cancer Staging Manual 6th Edition. New York: Springer; 2002:179–184

  2. Greene FL, Page DL, Fleming ID, et al.: Lung. In AJCC Cancer Staging Manual 6th Edition. New York: Springer; 2002:167–178

  3. Flores RM, Routledge T, Seshan VE, et al.: The impact of lymph node station on survival in 348 surgically resected malignant pleural mesothelioma (MPM) patients: implications for revision of the AJCC staging system. J Thorac Cardiovasc Surg. doi:10.1016/j.jtcvs.2008.02.069

  4. Flores RM, Pass HI, Seshan VE, et al. Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: Results in 663 patients. J Thorac Cardiovasc Surg 2008; 135(3): 620–626. doi:10.1016/j.jtcvs.2007.10.054

    Article  PubMed  Google Scholar 

The largest series of surgical patients comparing EPP to P/D.

  1. Rusch VW, Rosenzweig K, Venkatraman E, et al. A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2001;122(4):788–795. doi:10.1067/mtc.2001.116560

    Article  CAS  PubMed  Google Scholar 

  2. Pass HI, Temeck BK, Kranda K, et al. Phase III randomized trial of surgery with or without intraoperative photodynamic therapy and postoperative immunochemotherapy for malignant pleural mesothelioma. Ann Surg Oncol 1997; 4:628–633. doi:10.1007/BF02303746

    Article  CAS  PubMed  Google Scholar 

  3. Rusch V, Saltz L, Venkatraman E, et al. A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma. J Clin Oncol 1994; 12:1156–1163.

    CAS  PubMed  Google Scholar 

  4. Richards WG, Zellos L, Bueno R, et al. Phase I to II study of pleurectomy/decortication and intraoperative intracavitary hyperthermic cisplatin lavage for mesothelioma. J Clin Oncol 2006;24:1561–1567. doi:10.1200/JCO.2005.04.6813

    Article  CAS  PubMed  Google Scholar 

  5. Sterman DH, Kaiser LR, Albelda SM. Advances in the treatment of malignant pleural mesothelioma. Chest. 1999;116:504–520. doi:10.1378/chest.116.2.504

    Article  CAS  PubMed  Google Scholar 

  6. Rice DC, Stevens WS, Correa AM, et al. Outcomes after extrapleural pneumonectomy and Intensity-Modulated Radiation Therapy for malignant pleural mesothelioma. Ann Thorac Surg 2007; 84: 1685–1693. doi:10.1016/j.athoracsur.2007.04.076

    Article  PubMed  Google Scholar 

  7. Byrne MJ, Davidson JA, Musk AW, et al. Cisplating and gemcitabine treatment for malignant pleural mesothelioma: a phase II study. J Clin Oncol 1999; 17:25–30.

    CAS  PubMed  Google Scholar 

  8. Vogelzang NJ, Rusthoven JJ, Symanowski J, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 2003; 21:2636–2644. doi:10.1200/JCO.2003.11.136

    Article  CAS  PubMed  Google Scholar 

The first study to show a significant survival difference for unresectable mesothelioma patients treated with chemotherapy.

  1. Weder W, Kestenholz P, Taverna C, et al. Neoadjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma. J Clin Oncol 2004;22(17):3451-7.27.

    Article  CAS  PubMed  Google Scholar 

  2. Flores RM, Krug LM, Rosenzweig KE, et al.: Induction chemotherapy, Extrapleural pneumonectomy, and postoperative high dose radiotherapy for locally advanced malignant pleural mesothelioma: a phase II trial. J Thorac Oncol 2006, 1(4): 289–295. doi:10.1097/01243894-200605000-00004

    Google Scholar 

  3. Krug LM, Pass HI, Rusch VW, et al: A multicenter phase 2 trial of neo-adjuvantpemetrexed plus cisplatin (PC) followed by extrapleural pneumonectomy (EPP) and radiation (RT) for malignant pleural mesothelioma (MPM). J Clin Oncol 2006; 23:7179

    Google Scholar 

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Correspondence to Raja Flores MD.

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Kent, M., Rice, D. & Flores, R. Diagnosis, Staging, and Surgical Treatment of Malignant Pleural Mesothelioma. Curr. Treat. Options in Oncol. 9, 158–170 (2008). https://doi.org/10.1007/s11864-008-0070-4

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  • DOI: https://doi.org/10.1007/s11864-008-0070-4

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