Surgery in Malignant Pleural Mesothelioma

Bueno, Raphael; Opitz, Isabelle

doi:10.1016/j.jtho.2018.08.001

Cited by 66 publications

(59 citation statements)

References 92 publications

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“…It is common after the first line of diagnostic, to scrutinize the pleural effusion by a cyto-/histological examination. Because of low sensitivity, fine needle biopsy is commonly not recommended (29). For Carbone et al, pleural effusion is the first material to be obtained, here the experience of the examiner is crucial, because the sensitivity can vary from <5 to >90%.…”

Section: Diagnosticmentioning

confidence: 99%

“…Different scoring systems can be found in the international Literature even if they have been extrapolated from retrospective studies. The greatest advantages given by prognostic scores is the possible use of an individual case based, patient-oriented therapy, which could improve outcomes (29 (1). In addition, there are prognostic factors mentioned in other publications like the restriction of the tumor to one half of the thorax, missing evidence of histological lymph node involvement and a slight cancer spread (29).…”

Section: Prognostic Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology, diagnosis and treatment of the malignant pleural mesothelioma, a narrative review of literature

Schumann¹,

Kocher²,

Minervini³

2021

J Thorac Dis

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The malignant pleural mesothelioma is a very aggressive tumor which is arising from mesothelial cells and is associated with asbestos exposure. It is a heterogeneous cancer that shows a complex pattern of molecular changes, including genetic, chromosomic, and epigenetic abnormalities. The malignant pleural mesothelioma is characterized by a silent and slow clinical progression with an average period of 20-40 years from the asbestos exposure phase to the start of the symptoms. Unfortunately, to date, the therapeutic options are very limited, especially if the tumor is detected late. This narrative review provides an extended overview of the present evidence in the literature regarding the epidemiology, diagnostic pathways and treatment approaches of the malignant pleural mesothelioma. The treatment of mesothelioma has evolved slowly over the last 20 years not only from a surgical point of view but also radiotherapy, chemotherapy and immunotherapy play nowadays a key role. Several surgical strategies are available ranging from extrapleural pneumonectomy to cytoreductive surgery but a multidisciplinary approach seems to be mandatory because a single approach has not proved to date to be resolutive. New non-surgical treatment options appear to be promising but the results have to be taken in account with caution because clear evidence with high-quality studies is still lacking

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Section: Diagnosticmentioning

confidence: 99%

Section: Prognostic Factorsmentioning

confidence: 99%

Epidemiology, diagnosis and treatment of the malignant pleural mesothelioma, a narrative review of literature

Schumann¹,

Kocher²,

Minervini³

2021

J Thorac Dis

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“…VATS offers the additional benefit of allowing the performance of more invasive surgical interventions, such as lung resection and tumour debulking, at the same time as the diagnostic procedure. It is important to note that VATS can be performed under local anaesthesia on non-intubated patients [185].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma

Opitz

Scherpereel

Berghmans

et al. 2020

European Journal of Cardio-Thoracic Surgery

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The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009–2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally via image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in ∼10% of cases, justifying the use of specific markers, including BAP-1 and CDKN2A (p16) for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pretherapeutic assessment. Monitoring: patient’s performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasize that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres.

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“…As distinct biomarkers are lacking [15], early detection is often impeded, thereby worsening patients' outcome. Unfortunately, only a small fraction of patients is suitable for pleurectomy [16], while most patients are treated with a cisplatin/pemetrexed combination. The treatment may prolong overall survival by 3 months [5].…”

Section: Introductionmentioning

confidence: 99%

Digital Gene Expression Analysis of Epithelioid and Sarcomatoid Mesothelioma Reveals Differences in Immunogenicity

Brčić

Mathilakathu

Walter

et al. 2021

Cancers

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Malignant pleural mesothelioma (MPM) is an aggressive malignancy associated with asbestos exposure. Median survival ranges from 14 to 20 months after initial diagnosis. As of November 2020, the FDA approved a combination of immune checkpoint inhibitors after promising intermediate results. Nonetheless, responses remain unsatisfying. Adequate patient stratification to improve response rates is still lacking. This retrospective study analyzed formalin fixed paraffin embedded specimens from a cohort of 22 MPM. Twelve of those samples showed sarcomatoid, ten epithelioid differentiation. Complete follow-up, including radiological assessment of response by modRECIST and time to death, was available with reported deaths of all patients. RNA of all samples was isolated and subjected to digital gene expression pattern analysis. Our study revealed a notable difference between epithelioid and sarcomatoid mesothelioma, showing differential gene expression for 304/698 expressed genes. Whereas antigen processing and presentation to resident cytotoxic T cells as well as phagocytosis is highly affected in sarcomatoid mesothelioma, cell–cell interaction via cytokines seems to be of greater importance in epithelioid cases. Our work reveals the specific role of the immune system within the different histologic subtypes of MPM, providing a more detailed background of their immunogenic potential. This is of great interest regarding therapeutic strategies including immunotherapy in mesothelioma.

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Surgery in Malignant Pleural Mesothelioma

Cited by 66 publications

References 92 publications

Epidemiology, diagnosis and treatment of the malignant pleural mesothelioma, a narrative review of literature

Epidemiology, diagnosis and treatment of the malignant pleural mesothelioma, a narrative review of literature

ERS/ESTS/EACTS/ESTRO guidelines for the management of malignant pleural mesothelioma

Digital Gene Expression Analysis of Epithelioid and Sarcomatoid Mesothelioma Reveals Differences in Immunogenicity

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