Abstract
Malignant pleural mesothelioma (MPM) is a relatively rare thoracic malignancy accounting for about 2000–3000 new cases per year. This cancer has been increasing in incidence and is strongly associated with asbestos exposure. Also, it is characterized by insidious growth and clinical presentation at an advanced stage of disease. In the past, the treatment of this disease was limited to marginally effective chemotherapy and morbid surgery. This review explores the clinical presentation of MPM, its diagnostic approach and the relevant and recent studies that define the role of chemotherapy, radiation, and various surgical options. Currently, even with aggressive surgical interventions and multimodality strategies, cure remains elusive, although life prolongation has been achieved. Additionally, promising new therapies and interventions that are currently being studied are introduced in this review.
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Yang H, Testa JR, Carbone M. Mesothelioma epidemiology, carcinogenesis, and pathogenesis. Curr Treat Options Oncol. 2008;9(2–3):147–57.
Milne JE. Thirty-two cases of mesothelioma in Victoria, Australia: a retrospective survey related to occupational asbestos exposure. Br J Ind Med. 1976;33(2):115–22.
Greenberg M, Davies TA. Mesothelioma register 1967–68. Br J Ind Med. 1974;31(2):91–104.
Chirieac LR, Corson JM. Pathologic evaluation of malignant pleural mesothelioma. Semin Thorac Cardiovasc Surg. 2009;21(2):121–4.
Belli C, Anand S, Tassi G, Fennell D, Mutti L. Translational therapies for malignant pleural mesothelioma. Expert Rev Respir Med. 2010;4(2):249–60.
Ruffie P, Feld R, Minkin S, et al. Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients. J Clin Oncol. 1989;7(8):1157–68.
Lee ST, Ghanem M, Herbertson RA, et al. Prognostic value of 18F-FDG PET/CT in patients with malignant pleural mesothelioma. Mol Imag Biol. 2009;11(6):473–9.
Flores RM, Akhurst T, Gonen M, Larson SM, Rusch VW. Positron emission tomography defines metastatic disease but not locoregional disease in patients with malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2003;126(1):11–6.
Edge SB, American Joint Committee on Cancer. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
Schouwink JH, Kool LS, Rutgers EJ, et al. The value of chest computer tomography and cervical mediastinoscopy in the preoperative assessment of patients with malignant pleural mesothelioma. Ann Thorac Surg. 2003;75(6):1715–8. discussion 1718–1719.
Erasmus JJ, Truong MT, Smythe WR, et al. Integrated computed tomography-positron emission tomography in patients with potentially resectable malignant pleural mesothelioma: staging implications. J Thorac Cardiovasc Surg. 2005;129(6):1364–70.
Rice DC, Erasmus JJ, Stevens CW, et al. Extended surgical staging for potentially resectable malignant pleural mesothelioma. Ann Thorac Surg. 2005;80(6):1988–92. discussion 1992–1983.
Schneider DB, Clary-Macy C, Challa S, et al. Positron emission tomography with f18-fluorodeoxyglucose in the staging and preoperative evaluation of malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2000;120(1):128–33.
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(14):2636–44.
Dougherty TJ, Gomer CJ, Henderson BW, et al. Photodynamic therapy. J Natl Cancer Inst. 1998;90(12):889–905.
Friedberg JS. Photodynamic therapy as an innovative treatment for malignant pleural mesothelioma. Semin Thorac Cardiovasc Surg. 2009;21(2):177–87.
•Wolf AS, Daniel J, Sugarbaker DJ. Surgical techniques for multimodality treatment of malignant pleural mesothelioma: extrapleural pneumonectomy and pleurectomy/decortication. Semin Thorac Cardiovasc Surg. Summer 2009;21(2):132–148. This article clearly explains the technical nuances of performing extrapleural pneumonectomies and pleurectomy/decortication.
••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, 626 e621-623. This study showed that both extrapleural pneumonectomies and pleurectomy/decortication have comparable outcomes for the treatment of mesothelioma.
Sugarbaker DJ, Jaklitsch MT, Bueno R, et al. Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies. J Thorac Cardiovasc Surg. 2004;128(1):138–46.
Soysal O, Karaoglanoglu N, Demiracan S, et al. Pleurectomy/decortication for palliation in malignant pleural mesothelioma: results of surgery. Eur J Cardiothorac Surg. 1997;11(2):210–3.
Balduyck B, Trousse D, Nakas A, Martin-Ucar AE, Edwards J, Waller DA. Therapeutic surgery for nonepithelioid malignant pleural mesothelioma: is it really worthwhile? Ann Thorac Surg. 2010;89(3):907–11.
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(1):54–63. discussion 63–55.
Ceresoli GL, Locati LD, Ferreri AJ, et al. Therapeutic outcome according to histologic subtype in 121 patients with malignant pleural mesothelioma. Lung Cancer. 2001;34(2):279–87.
Neragi-Miandoab S, Richards WG, Sugarbaker DJ. Morbidity, mortality, mean survival, and the impact of histology on survival after pleurectomy in 64 patients with malignant pleural mesothelioma. Int J Surg. 2008;6(4):293–7.
Zellos L, Richards WG, Capalbo L, et al. A phase I study of extrapleural pneumonectomy and intracavitary intraoperative hyperthermic cisplatin with amifostine cytoprotection for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2009;137(2):453–8.
Tilleman TR, Richards WG, Zellos L, et al. Extrapleural pneumonectomy followed by intracavitary intraoperative hyperthermic cisplatin with pharmacologic cytoprotection for treatment of malignant pleural mesothelioma: a phase II prospective study. J Thorac Cardiovasc Surg. 2009;138(2):405–11.
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(10):1561–7.
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(6):1156–63.
Lee JD, Perez S, Wang HJ, Figlin RA, Holmes EC. Intrapleural chemotherapy for patients with incompletely resected malignant mesothelioma: the UCLA experience. J Surg Oncol. 1995;60(4):262–7.
van Ruth S, Baas P, Haas RL, Rutgers EJ, Verwaal VJ, Zoetmulder FA. Cytoreductive surgery combined with intraoperative hyperthermic intrathoracic chemotherapy for stage I malignant pleural mesothelioma. Ann Surg Oncol. 2003;10(2):176–82.
Kotsakis A, Georgoulias V. Targeting epidermal growth factor receptor in the treatment of non-small-cell lung cancer. Expert Opin Pharmacother. 2010;11(14):2363–89.
Govindan R, Kratzke RA, Herndon 2nd JE, et al. Gefitinib in patients with malignant mesothelioma: a phase II study by the Cancer and Leukemia Group B. Clin Cancer Res. 2005;11(6):2300–4.
Garland LL, Rankin C, Gandara DR, et al. Phase II study of erlotinib in patients with malignant pleural mesothelioma: a Southwest Oncology Group Study. J Clin Oncol. 2007;25(17):2406–13.
Leigh RA, Webster I. Lymphocytic infiltration of pleural mesothelioma and its significance for survival. S Afr Med J. 1982;61(26):1007–9.
Gregoire M. What’s the place of immunotherapy in malignant mesothelioma treatments? Cell Adhes Migrat. 2010;4(1):153–61.
Aelony Y, Yao JF. Prolonged survival after talc poudrage for malignant pleural mesothelioma: case series. Respirology. 2005;10(5):649–55.
Ak G, Metintas M, Yildirim H, et al. Pleurodesis in follow-up and treatment of malignant pleural mesothelioma patients. Tüberk Toraks. 2009;57(1):22–31.
Murthy SC, Okereke I, Mason DP, Rice TW. A simple solution for complicated pleural effusions. J Thorac Oncol. 2006;1(7):697–700.
Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion. Chest. 2006;129(2):362–8.
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Raja, S., Murthy, S.C. & Mason, D.P. Malignant Pleural Mesothelioma. Curr Oncol Rep 13, 259–264 (2011). https://doi.org/10.1007/s11912-011-0177-9
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DOI: https://doi.org/10.1007/s11912-011-0177-9