The Proposed New International TNM Staging System for Malignant Pleural Mesothelioma: Application to Imaging
|
|
- Holly Clarke
- 8 years ago
- Views:
Transcription
1 :. #{149} :. #{149}..: #{149}. #{149}. :- : Received June 22, 1995; accepted after revision September 12, Department of Radiology, Duke University Medical Center, Box 3808, Dunham, NC Address correspondence to E. F. Patz, Jr. 2Division of Thonacic Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY AJR 1996;166: X/96/ American Roentgen Ray Society Perspective The Proposed New International TNM Staging System for Malignant Pleural Mesothelioma: Application to Imaging Edward F. Patz, 1, Valerie W. Rusch2, Robert Heelan3 Malignant pleural mesothelioma (MPM) Is an uncommon and usually fatal primary neoplasm of the pleura. In the past, response to standard therapy has been poor [1-3], but recent studies suggest that some patients may benefit from various therapeutic options, including surgical resection, combined technique treatment, and Immunotherapy [4-i]. With improvements in therapy, an accurate, widely accepted staging system will be important in selecting homogeneous groups of patients for entry into clinical trials. Multiple staging systems have previously been proposed for MPM, but none are universally used (8]. To address this problem, members of the International Mesothelioma Interest Group, a multidisciplinary group of thoracic surgeons, radiation and medical oncologists, pathologists, and radiologists, met in June 1994 during the fourth International Association for the Study of Lung Cancer Conference to develop a new staging system. The purpose of the workshop was to develop a consensus on clinical, radiographic, and pathologic staging that would be internationally accepted for clinical trials. The proposed new International Mesothelioma Interest Group staging system is a TNM system, derived from recent data suggesting that overall survival in MPM is related to the extent of the primary tumor (T status) and to lymph node involvement (N status) [4, 9, 10]. Although the ability of CT and MR imaging to stage MPM accurately in this new system is under investigation, the objective of this manuscript is to emphasize how the new staging system may be applied to radiographic evaluation. NewTNM Staging System The rationale for the proposed new staging criteria for MPM has been described previously [1 1], and an outline of the system is shown in Tables 1-3. It includes precise TNM descriptors, which are grouped into four stages. These TNM descriptors are primarily based on surgical and pathologic findings but are also potentially applicable to radiographic staging by CT and MR imaging. Tia describes an early tumor that involves only the ipsilateral parietal pleura with or without tumor on the diaphragmatic or mediastinal pleura. Tib describes a slightly more advanced tumor that involves all pleural surfaces, including the visceral pleura. Patients with Ti disease usually have a free pleural space and present with a large pleural effusion (Fig. 1). T2 designates a tumor that cannot be fully removed without resecting the underlying lung (Figs. 2A and 2B). Usually, the diaphragmatic muscle is also involved. Patients with T2 disease may still have a free pleural space with an effusion, but the panetal and visceral pleural surfaces have often begun to fuse. As such, the pleural effusion may have resolved or be loculated. T3 describes a locally advanced tumor that is still potentially amenable to surgical resection of all gross disease. In addition to involvement of all the pleural surfaces, there may be areas of tumor extension into the endothoracic fascia or the mediastinal fat. The surface of the pericardium may be involved such that partial pericardiectomy rather than just removal of the
2 324 PATZ ET AL. AJR:166, February 1996 TABLE 1 : T Descriptor Status Region Involved Characteristics Tia Limited to ipsilateral panietal pleura, including No involvement of visceral pleura mediastinal and diaphragmatic pleura Tlb Ipsilateral panietal pleura, including mediastinal and Scattered foci of tumor also involving visceral pleura diaphnagmatic pleura T2 Each ipsilateral pleural sunfacea At least one of the following:. Involvement of diaphragmatic muscle SConfluent visceral pleural tumor (including fissures) or extension of tumor from visceral pleura into underlying pulmonary parenchyma T3 Locally advanced but potentially resectable tumor; each ipsilatenal pleural sunfacea T4 Locally advanced technically unresectable tumor; each ipsilateral pleural sunfacea a Panietal, mediastinal, diaphnagmatic, and visceral pleura. TABLE 2: N and M Designations Designation Description NX Regional lymph nodes not assessable NO No regional lymph node metastases Ni Metastases in ipsilatenal bronchopulmonary or hilar lymph nodes N2 Metastases in subcannal or ipsilateral mediastinal lymph nodes, including ipsilateral internal mammary nodes N3 Metastases in contralateral mediastinal, contralatenal internal mammary, and ipsilateral on contralateral supraclavicular lymph nodes MX Distant metastases not assessable MO No distant metastases Ml Distant metastases present TABLE 3: Stages Stage Status Lymph Node Metastases Ia Tia NO MO lb Tib NO MO II T2 NO MO Ill AnyT3 AnyNl orn2 MO IV AnyT4 AnyN3 Any Ml mediastinal pleura overlying the pericardium is required (Figs. 3A-3C). A solitary, completely resectable focus of tumor At least one of the following: #{149} Involvement of endothoracic fascia #{149} Extension into mediastinal fat #{149} Solitary, completely resectable focus of tumor extending into soft tissues of chest wall #{149} Nontransmural involvement of penicardium At least one of the following: #{149} Diffuse extension or multifocal masses of tumor in chest wall, with or without associated rib destruction #{149} Direct transdiaphnagmatic extension of tumor to pentoneum #{149} Direct extension of tumor to contralateral pleura #{149} Direct extension of tumor to one or more mediastinal organs #{149} Direct extension of tumor into spine #{149} Tumor extending through to internal surface of penicardium with on without pericardial effusion, or tumor involving myocardium extending directly into the chest wall is also included in the T3 category. This focus usually occurs in patients who have a tumor implant in the chest wall at the site of a previous diagnostic thoracentesis, pleural biopsy, or thoracoscopy. It is also occasionally seen in patients who present with a dominant parietal pleural mass. Although no data indicate that a specific size limitation should be placed on the area of chest wall involvement, the concept of focal direct extension of tumor is similar to that used in the T3 category of the lung cancer staging system. This is surgically quite distinct from a very locally advanced tumor that is technically unresectable because it diffusely invades the intercostal or chest wall muscles. T4 designates a locally advanced and technically unresectable tumor. In addition to involvement of all the pleural surfaces, T4 is characterized by features including diffuse extension of tumor into the chest wall, direct extension through the diaphragm to the underlying peritoneum, or direct extension to the contralateral pleura, the mediastinal organs, the spine, the myocardium, or the internal surface ofthe pericardium (Fig. 4). The descriptors for the N status are identical to those used in the International Lung Cancer Staging System [12]. Ni describes involvement of the ipsilateral bronchopulmonary and hilar lymph nodes, and N2 describes involvement ofthe subcarinal or ipsilateral mediastinal lymph nodes and the ipsilateral internal mammary nodes. N3 designates metastases in the contralateral mediastinal, contralateral internal mammary, or ipsilateral or contralateral supraclavicular lymph nodes. The descriptors for M status are identical to those used for all other solid tumors. MO designates no evidence of metastatic disease, whereas Mi describes the presence of metastases outside the ipsilateral hemithorax (Fig. 5).
3 AJR:166, February 1996 NEW STAGING FOR MESOTHELIOMA 325 Fig. 1.-Diffuse right-sided pleural disease in 69-year-old woman with resectable malignant pleural mesotheiioma. T2-weighted cardiac gated image (10-mm slice thickness) at level of left atrium shows large amount of fluid with only minimal soft-tissue component. In major fissure there is soft-tissue density, somewhat ovoid, corresponding to tumor involving visceral pleura (arrow). Radlologically, this wasti tumor and was confirmed at surgery to be Ti b. Fig. 2.-Encasement of right hemithorax in 75-year-old man with resectable malignant pleural mesothelioma. A, CT image at level of pulmonary artery demonstrates right pleural effusion posteriorly and bulky tumor anteriorly. Tumor appears to extend into anterior mediastinum and thus was radiologically T3 lesion (arrow). At thoracotomy, however, there was no mediastinal invasion, but invagination of mediastinal fat by tumor. Pathologically, lesion was thus T2. B, CoronalTl -weighted (5-mm slice thickness) cardiac gated view of anterior thorax shows bulky tumor compressing mediastinal structures. Smooth borders (arrow) suggest possibility of extrinsic pressure or Invaginatlon rather than true Invasion (T2 lesion). This tumor was completely resected at thoracotomy. Fig. 3.-Scattered focal soft-tissue pleural abnormality in 53-year-old woman with resectable malignant pleural mesothelioma. A, High-resolution CT scan (1.5-mm slice thickness) at level below carina shows extension of tumor beyond endothoracic fascia to involve intercostal regions in anterior chest wall (arrow). Thus, lesion was T3. Focal chest wall invasion was confirmed at surgery. In mediastinum, there is soft-tissue fullness to right of esophagus, suggesting enlarged mediastinal lymph node (N2 disease) (arrowhead). At thoracotomy, this proved to be an enlarged hyperplastic lymph node in the subcarinal region, which did not contain tumor (NO disease). B, T2-weighted cardiac gated (10-mm slice thickness) axial scan at level of aortlc valve plane also shows tumor within chest wall anteriorly (black arrow). In addition, tumor is seen in major fissure, involving visceral pleura (white arrow), and along mediastinal surface adjacent to heart (curved arrow). Pleural effusion is present in posterior pleural space. C, High-resolutIon (1.5-mm slice thickness) CT scan through lower chest shows subtle mass (arrow) adjacent to or involving pericardium. At surgery, full thickness of pericardium was involved by mesothelioma in this region (T3 lesion). Tumor is also present in major fissure. These TNM descriptors are used to characterize four stages of disease. Stages I and II include only node-negative tumors. Stage I is subdivided into Ia and lb on the basis of the difference in T status between Tia and Tib. Stage II includes only T2NO tumors. Stage III includes any T3, any Ni, or any N2, MO tumors. Stage IV includes any T4, N3, or Ml tumors. Discussion Until recently, little effort was made to stage MPM because it was a rare malignancy for which there was no effective treatment. However, the increasing occurrence of MPM makes it necessary to have a staging system that will stratify patients into homogeneous prognostic groups to evaluate new treat-
4 326 PATZ ET AL. AJR:166, February 1996 ment options in prospective clinical trials [13]. The staging system should be applicable to radiographic as well as to surgical and pathologic staging so that patients can be selected accurately for either surgical resection or nonsurgical therapy. The importance of having an accurate staging system and of identifying prognostic factors is well accepted in the study and treatment of other solid tumors and has facilitated selection of patients for novel treatment strategies. To improve the currently poor prognosis of MPM, systematic staging and classification of patients should be used in prospective multiinstitutional clinical trials. At least five staging systems for MPM have been proposed previously [8]. The staging system presented here defines specific TNM descriptors on the basis of emerging information about the natural history of MPM. This new staging system separates out subsets of patients with early, surgically resectable tumors. Previously, these categories were grouped together. The rising frequency of MPM and the increasing use of thoracoscopy for its early diagnosis as well as the apparently better prognosis of these tumor subsets justifies this stage grouping. Radiologic assessment of these tumors is integral to patient management, although surgical confirmation is often necessary. It appears that CT and MR imaging cannot always distinguish among Ti a, Ti b, and T2 because these techniques cannot usually differentiate parietal from visceral involvement or consistently detect diaphragmatic muscle invasion. However, in these early stages CT and MR imaging can evaluate the presence of a significant pleural effusion (Ti disease) and usually can differentiate it from extension of tumor through the visceral pleural to involve underlying lung parenchyma (T2 disease) [14]. Among patients with more locally advanced tumors, the distinction between T3 and T4 has obvious implications for surgical resection and apparently significant differences in survival. CT and MR imaging may have an impact in distinguishing T3 (potentially resectable MPM) from T4 (technically unresectable MPM) disease: these techniques can frequently aid in the diagnosis of several T3 categories (e.g., extension into mediastinal fat, solitary resectable chest wall tumor focus). Diagnosis by CT and MR imaging of involvement of the endothoracic fascia is considerably more difficult, representing anatomic distinctions at the limits of current imaging Fig. 4.-Diffuse tumor encasement of the right hemithorax in 73-year-old man with unresectable malignant pleural mesothelioma. CT scan through lower thorax shows thin soft-tissue rind (-5 mm) anteriorly and moderate pleural effusion. Within lateral chest wall fat, tissue infiltration increases subtly beyond the endothoracic fascia (arrows). At surgery, extensive tumor infiltration into chest wall was noted, precluding resection.this wast4 tumor. Fig. 5.-Metastatic disease in 74-year-old man with unresectable malignant pleural mesothelioma (MPM). CT image shows multiple small pulmonary nodules in right lung, pathologically proven to represent metastatic (Ml) MPM. capabilities. Similarly, involvement of the pericardium can be difficult to ascertain if there is anything less than extension through the entire thickness of the pericardium with effusion [i 5, 16]. Experience with detecting transdiaphragmatic extension of tumor to the peritoneum is limited. The coronal and sagittal capabilities of MR imaging may prove advantageous in this specific area [17, 18]. In imaging, the tendency is to understage the true extent of MPM, that is, to miss significant disease [15]. Understaging may be less important in the resectable stages (Ti-T3) but assumes greater importance in the diagnosis of T4 (unresectable) disease. At present, a percentage of patients in whom Ti-T3 disease is diagnosed by imaging may be presumed to have unresectable T4 disease at surgical exploration. The frequency of nodal involvement and its prognostic implications have only recently been investigated. The anatomic distinction between Ni, N2, and N3 nodes is familiar to all physicians caring for patients with thoracic neoplasms. Littie information is available about diagnosis by CT and MR imaging of nodal (Ni-N3) involvement in MPM. Preliminary experience in patients undergoing both resection of MPM and extensive mediastinal node sampling from a prospective study being performed by two of the authors found six of i 2 patients to have grossly suspicious nodes at surgery but no significant adenopathy on imaging studies. Two of the patients had histologically negative, hyperplastic nodes on pathologic examination; the rest were aggregates of lymph nodes, containing a total of 31 nodes, of which 1 i were positive for MPM. The largest single node was i.6 cm in diameter, and the vast majority were within normal size limits. Therefore, two factors may render imaging diagnosis of N disease difficult: involved nodes may not be enlarged, and large portions of the ipsilateral hilum and mediastinum may be obscured by bulky sheets of locally invasive or adjacent tumor. Systematic imaging searches for distant spread of MPM are not common when systemic symptomatology is absent and when the primary tumor appears to be at an early stage. Consequently, little imaging information is available about Mi spread of MPM. Although radiologic staging with CT or MR imaging provides a tremendous amount of information, surgical staging in
5 AJR:166, February 1996 NEW STAGING FOR MESOTHELIOMA 327 patients with potentially resectable lesions is often required [16]. In many respects, these discrepancies are similar to those seen in the radiographic staging of lung cancer. Were CT or MR imaging coupled with thoracoscopy, mediastinoscopy, and, when indicated, biopsies of other sites, it is likely that this staging system could stratify patients in clinical trials that do not include thoracotomy and surgical resection. No TNM staging system fully recognizes the pathologic and biologic variables that influence survival. Many factors are reported to be prognostic in MPM, including histology, age, sex, performance status, type of symptoms, weight loss, history of asbestos exposure, and platelet count [1, 10, 19-22]. Of these, only histology appears to be universal across all reported series. Epithelial histology is always associated with a significantly better outcome than other cell types. Although the TNM staging system presented here can accurately describe the anatomic extent of disease, clinical trials will also need to stratify tumors by histology for the purposes of survival analyses. Our understanding of MPM continues to evolve as we learn more about the biology and treatment of this disease. Despite limitations in the accuracy of CT and MR imaging, the new International Mesothelioma Interest Group staging system can be applied to the radiographic staging of MPM and will provide the framework for the prospective clinical studies that may alter the currently poor prognosis of MPM. ACKNOWLEDGMENT We thank Melody Owens for her expert assistance in the preparation of this manuscript. REFERENCES 1. Ruftie R, Feld R, Minkin 5, et al. Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients. J C/in Oncol 1989;7: Knanup-Hansen A, Hansen HH. Chemotherapy in malignant mesothelioma: a review. Cancer Chemother Pharmacol 1991:28: Alberts AS, Falkson G, Goedhals L, Vorobiof DA, Van Den Merwe CA. Malignant pleural mesothelioma: a disease unaffected by current therapeutic maneuvers. J C/in Oncol 1988;6: Sugarbaker DJ, Heher EC, Lee TH, et al. Extrapleural pneumonectomy, chemotherapy, and radiotherapy in the treatment of diffuse malignant pleural mesothelioma. J Thorac Cardiovasc Surg 1991:102: Pass HI. Contemporary approaches in the investigation and treatment of malignant pleural mesothelioma. ChestSurg Clin NAm 1994:4: Boutin C, Viallat J-R, Van Zandwijk N, et al. Activity of intrapleural recombinant gamma-interferon in malignant mesothelioma. Cancer : Buchart EG, Gibbs AR. Pleural mesothelioma. Curr Opin Oncol 1990:2: Dimitrov NV, McMahon S. Presentation, diagnostic methods, staging, and natural history of malignant mesothelioma. In: Antman K, Aisner J, eds. Asbestos-related malignancy. Orlando: Grune & Stratton, 1987: Sugarbaker DJ, Strauss GM, Lynch TJ, et al. Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma. J C/inOncol 1993:11: Tammilehto L, Kivisaani L, Salminen US, Maasilta P, Mattson K. Evaluation of the clinical TNM staging system for malignant pleural mesothelioma: an assessment in 88 patients. Lung Cancer 1995:12: Rusch VW, the International Mesothelioma Interest Group. A proposed new international TNM staging system for malignant pleural mesothelioma. Chest 1995;108: Mountain CF. A new international staging system for lung cancer. Chest 1986;89(suppl): Osteen AT. Cancer manual, 8th ed. Boston: American Cancer Society, 1990: Kawashima A, Libshitz HI. Malignant pleural mesothelioma: CT manifestations in 50 cases. AJR 1990:155: Ausch VW, Godwin JD, Shuman WR The role of computed tomography scanning in the initial assessment and the follow-up of malignant pleural mesothelioma. J Thorac Cardiovasc Surg 1988:96: Law MA, Gregor A, Husband JE, Kerr H. Computed tomography in the assessment of malignant mesothelioma of the pleura. Clin Radiol 1982:33: Patz EF, Shatter K, Piwnicka-Worms DR, et al. Malignant pleural mesothelioma: value of CT and MA imaging in predicting resectability. AJR 1992:159: Lonigan JG, Libshitz HI. MA imaging of malignant pleural mesothelioma. J Comput Assist Tomogrl989;13: Tammilehto L. Malignant mesothelioma: prognostic factors in a prospective study of 98 patients. Lung Cancer 1992:8: Rusch VW, Piantadosi S, Holmes EC. The role of extrapleural pneumonectomy in malignant pleural mesothelioma. J Thorac Cardiovasc Surg 1991;102: Spirtas A, Connelly AR, Tucker MA. Survival patterns for malignant mesothelioma: the SEER experience. lntj Cancer 1988:41: Antman KH, Shemin A, Ryan L, et al. Malignant mesothelioma: prognostic variables in a registry of 180 patients, the Dana-Farber Cancer Institute and Brigham and Women s Hospital experience over two decades, J C/in Onco/1988;6:
Extrapleural Pneumonectomy for Malignant Mesothelioma: Pro. Joon H. Lee 9/17/2012
Extrapleural Pneumonectomy for Malignant Mesothelioma: Pro Joon H. Lee 9/17/2012 Malignant Pleural Mesothelioma (Epidemiology) Incidence: 7/mil (Japan) to 40/mil (Australia) Attributed secondary to asbestos
More informationObjectives. Mylene T. Truong, MD. Malignant Pleural Mesothelioma Background
Imaging of Pleural Tumors Mylene T. Truong, MD Imaging of Pleural Tumours Mylene T. Truong, M. D. University of Texas M.D. Anderson Cancer Center, Houston, TX Objectives To review tumors involving the
More informationRecommendations for the Reporting of Pleural Mesothelioma
Recommendations for the Reporting of Pleural Mesothelioma Association of Directors of Anatomic and Surgical Pathology * DOI: 10.1309/6A30YQHBMTHEJTEM It has been evident for decades that pathology reports
More informationMalignant Mesothelioma Current Approaches to a Difficult Problem. Raja M Flores, MD Thoracic Surgery Memorial Sloan-Kettering Cancer Center
Malignant Mesothelioma Current Approaches to a Difficult Problem Raja M Flores, MD Thoracic Surgery Memorial Sloan-Kettering Cancer Center Malignant Pleural Mesothelioma Clinical Presentation Insidious
More informationSystem for Malignant Pleural Mesothelioma'
A Proposed New International TNM Staging System for Malignant Pleural Mesothelioma' From the International Mesothelioma Interest Group* Study objective: Investigation of the behavior and treatment of diffuse
More informationINTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER Prospective Mesothelioma Staging Project
INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER Prospective Mesothelioma Staging Project Data Forms and Fields in CRAB Electronic Data Capture System - Reduced Set - Pivotal data elements for developing
More informationProtocol for the Examination of Specimens From Patients With Malignant Pleural Mesothelioma
Protocol for the Examination of Specimens From Patients With Malignant Pleural Mesothelioma Based on AJCC/UICC TNM, 7th edition Protocol web posting date: February 1, 2011 Procedures Resection Authors
More informationProposed Adjustments to Pathologic Staging of Epithelial Malignant Pleural Mesothelioma Based on Analysis of 354 Cases
Original Article Proposed Adjustments to Pathologic Staging of Epithelial Malignant Pleural Mesothelioma Based on Analysis of 354 Cases William G. Richards, PhD 1,2 ; John J. Godleski, MD 2,3 ; Beow Y.
More informationDiscussion. AJR:159, November1992 MALIGNANT PLEURAL MESOTHELIOMA 965
AJR:159, November1992 MALIGNANT PLEURAL MESOTHELIOMA 965 Fig. 7.-45-year-old woman with unresectable malignant mesothelioma. CT scan shows lobular tumor rind with direct extension into azygoesophageal
More informationNeoplasms of the LUNG and PLEURA
Neoplasms of the LUNG and PLEURA 2015-2016 FCDS Educational Webcast Series Steven Peace, BS, CTR September 19, 2015 2015 Focus o Anatomy o SSS 2000 o MPH Rules o AJCC TNM 1 Case 1 Case Vignette HISTORY:
More informationMesothelioma. 1. Introduction. 1.1 General Information and Aetiology
Mesothelioma 1. Introduction 1.1 General Information and Aetiology Mesotheliomas are tumours that arise from the mesothelial cells of the pleura, peritoneum, pericardium or tunica vaginalis [1]. Most are
More informationClinical Indications and Results Following Chest Wall Resection
Clinical Indications and Results Following Chest Wall Resection for Recurrent Malignant Pleural Mesothelioma Ali SO, Burt BM, Groth SS, DaSilva MC, Yeap BY, Richards WG, Baldini EH and Sugarbaker DJ. Division
More informationبسم هللا الرحمن الرحيم
بسم هللا الرحمن الرحيم Updates in Mesothelioma By Samieh Amer, MD Professor of Cardiothoracic Surgery Faculty of Medicine, Cairo University History Wagner and his colleagues (1960) 33 cases of mesothelioma
More informationMesothelioma: Questions and Answers
CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Mesothelioma: Questions
More informationMalignant Pleural Diseases Advances Clinicians Should Know F Gleeson
Malignant Pleural Diseases Advances Clinicians Should Know F Gleeson The following relevant disclosures, conflicts of interest and/ or financial relationships exist related to this presentation: Consultant
More informationSurgical Management of Malignant Pleural Mesothelioma: A Clinical Practice Guideline
Evidence-based Series #7-14-2: Section 1 Surgical Management of Malignant Pleural Mesothelioma: A Clinical Practice Guideline D.E. Maziak, A. Gagliardi, A.E. Haynes, J.A. Mackay, W.K. Evans, and members
More informationUpdate on Mesothelioma
November 8, 2012 Update on Mesothelioma Intro incidence and nomenclature Update on Classification Diagnostic specimens Morphologic features Epithelioid Histology Biphasic Histology Immunohistochemical
More informationTreatment of mesothelioma in Bloemfontein, South Africa
European Journal of Cardio-thoracic Surgery 24 (2003) 434 440 www.elsevier.com/locate/ejcts Treatment of mesothelioma in Bloemfontein, South Africa W.J. de Vries*, M.A. Long Cardiothoracic Department,
More informationMesothelioma. Malignant Pleural Mesothelioma
Mesothelioma William G. Richards, PhD Brigham and Women s Hospital Malignant Pleural Mesothelioma 2,000-3,000 cases per year (USA) Increasing incidence Asbestos (50-80%, decreasing) 30-40 year latency
More informationSternotomy and removal of the tumor
Sternotomy and removal of the tumor All thymomas originate from epithelial thymic cells 4% of them consist of a pure population of epithelial cells Most have mixed populations of lymphoid cells to a
More informationResearch Article Frequency of Surgery in Black Patients with Malignant Pleural Mesothelioma
Disease Markers Volume 2015, Article ID 282145, 5 pages http://dx.doi.org/10.1155/2015/282145 Research Article Frequency of Surgery in Black Patients with Malignant Pleural Mesothelioma Emanuela Taioli,
More informationGUIDELINES FOR THE MANAGEMENT OF LUNG CANCER
GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER BY Ali Shamseddine, MD (Coordinator); as04@aub.edu.lb Fady Geara, MD Bassem Shabb, MD Ghassan Jamaleddine, MD CLINICAL PRACTICE GUIDELINES FOR THE TREATMENT
More informationA Practical Guide to Advances in Staging and Treatment of NSCLC
A Practical Guide to Advances in Staging and Treatment of NSCLC Robert J. Korst, M.D. Director, Thoracic Surgery Medical Director, The Blumenthal Cancer Center The Valley Hospital Objectives Revised staging
More informationPrimary -Benign - Malignant Secondary
TUMOURS OF THE LUNG Primary -Benign - Malignant Secondary The incidence of lung cancer has been increasing almost logarithmically and is now reaching epidemic levels. The overall cure rate is very low
More informationMalignant Pleural Mesothelioma in Singapore
RESEARCH COMMUNICATION C SP Yip 1, HN Koong 2, CM Loo 3, KW Fong 1* Abstract Aim: To examine the clinical characteristics and outcomes of malignant pleural mesothelioma (MPM) in Singapore. Methods and
More informationSmall Cell Lung Cancer
Small Cell Lung Cancer Types of Lung Cancer Non-small cell carcinoma (NSCC) (87%) Adenocarcinoma (38%) Squamous cell (20%) Large cell (5%) Small cell carcinoma (13%) Small cell lung cancer is virtually
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES LUNG SITE MESOTHELIOMA Lung Site Group Mesothelioma Date Guideline Created: April 2013 Authors: Dr. Meredith Giuliani, Dr. Andrea Bezjak 1.
More informationCardiac Masses and Tumors
Cardiac Masses and Tumors Question: What is the diagnosis? A. Aortic valve myxoma B. Papillary fibroelastoma C. Vegetation from Infective endocarditis D. Thrombus in transit E. None of the above Answer:
More informationUnderstanding Your Surgical Options for Lung Cancer
Information Booklet for Patients Understanding Your Surgical Options for Lung Cancer Understanding Lung Cancer If you have just been diagnosed with lung cancer, this booklet will serve as an informational
More informationScreening, early referral and treatment for asbestos related cancer
Screening, early referral and treatment for asbestos related cancer Marc de Perrot, MD, MSc, FRCSC Toronto Mesothelioma Research Program University of Toronto Asbestos related diseases Mesothelioma Lung
More informationClinical cases in Malignant Pleural Mesothelioma: Adherence to the ESMO Clinical Practice Guidelines
Clinical cases in Malignant Pleural Mesothelioma: Adherence to the ESMO Clinical Practice Guidelines Wieneke Buikhuisen The Netherlands Cancer Institute Amsterdam The Netherlands Case (1) Male, 56 year
More informationAccelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma
Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma Marc de Perrot, Ronald Feld, Natasha B Leighl, Andrew Hope, Thomas K Waddell, Shaf Keshavjee,
More informationMale. Female. Death rates from lung cancer in USA
Male Female Death rates from lung cancer in USA Smoking represents an interesting combination of an entrenched industry and a clearly drug-induced cancer Tobacco Use in the US, 1900-2000 5000 100 Per Capita
More informationMalignant pleural mesothelioma is a rare primary neoplasm,
Assessment of Malignant Pleural Mesothelioma with F-FDG Dual-Head Gamma-Camera Coincidence Imaging: Comparison with Histopathology Victor H. Gerbaudo, PhD 1 ; David J. Sugarbaker, MD 2 ; Scott Britz-Cunningham,
More information9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH
9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH Differentiated thyroid cancer expresses the TSH receptor on the cell membrane and responds to TSH stimulation by increasing
More informationPrincipal Investigator: Valerie W. Rusch, MD, FACS, Chief, Thoracic Surgery Memorial Sloan-Kettering Cancer Center
Protocol 1101-1088 Phase I study of intra-pleural administration of GL-ONC1 in patients with malignant pleural effusion: primary, metastases and mesothelioma Principal Investigator: Valerie W. Rusch, MD,
More informationLung Cancer Treatment Guidelines
Updated June 2014 Derived and updated by consensus of members of the Providence Thoracic Oncology Program with the aid of evidence-based National Comprehensive Cancer Network (NCCN) national guidelines,
More informationAhmed Farouk Abd El-Hafez, MD
Presented By Ahmed Farouk Abd El-Hafez, MD Lecturer of Cardiothoracic Surgery Assiut University Asbestos exposure : amphibole fibers especially crocidolite asbestos Nonasbestos Causes : Silicate fibers
More informationPlueral Malignancy: Radiologic-pathologic
Plueral Malignancy: Radiologic-pathologic Correlation Ritu R. Gill, MD Pleural Malignancies: Radiologic-Pathologic Correlation Ritu R Gill MD Brigham and Women s Hospital Boston, Massachusetts Pleural
More informationUse of imaging in the management of malignant pleural mesothelioma
Clinical Radiology (2005) 60, 1237 1247 REVIEW Use of imaging in the management of malignant pleural mesothelioma R.E. Benamore a, M.J. O Doherty b, J.J. Entwisle a, * a Department of Radiology, University
More informationThoracic Mesothelium. Protocol applies to malignant thoracic mesothelioma. Procedures Cytology (No Accompanying Checklist) Incisional Biopsy Resection
Thoracic Mesothelium Protocol applies to malignant thoracic mesothelioma. Protocol revision date: January 2004 Based on AJCC/UICC TNM, 6 th edition Procedures Cytology (No Accompanying Checklist) Incisional
More informationMultimodality Therapy of Malignant Pleural Mesothelioma Results in 120 Consecutive Patients
ANNALS OF SURGERY Vol. 224, No. 3. 288-296 C 1996 Lippincott-Raven Publishers Extrapleural Pneumonectomy in the Multimodality Therapy of Malignant Pleural Mesothelioma Results in 120 Consecutive Patients
More informationMalignant pleural mesothelioma: outcome of limited surgical management
Interactive Cardiovascular and Thoracic Surgery 2 (2003) 30 34 Institutional review Thoracic general Malignant pleural mesothelioma: outcome of limited surgical management Peter G. Phillips a, George Asimakopoulos
More informationHow To Treat Lung Cancer At Cleveland Clinic
Treatment Guide Lung Cancer Management The Chest Cancer Center at Cleveland Clinic, which includes specialists from the Respiratory Institute, Taussig Cancer Institute and Miller Family Heart & Vascular
More informationMesothelioma. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com ocft0101 Last reviewed: 03/21/2013 1
Mesothelioma Introduction Mesothelioma is a type of cancer. It starts in the tissue that lines your lungs, stomach, heart, and other organs. This tissue is called mesothelium. Most people who get this
More informationRound Table with Drs. Anne Tsao and Alex Farivar, Case 2: Mesothelioma
Round Table with Drs. Anne Tsao and Alex Farivar, Case 2: Mesothelioma I d like to welcome everyone, thanks for coming out to our lunch with experts. The faculty today are great people in the thoracic
More informationRecommendations for cross-sectional imaging in cancer management, Second edition
www.rcr.ac.uk Recommendations for cross-sectional imaging in cancer management, Second edition Breast cancer Faculty of Clinical Radiology www.rcr.ac.uk Contents Breast cancer 2 Clinical background 2 Who
More informationSMALL CELL LUNG CANCER
Protocol for Planning and Treatment The process to be followed in the management of: SMALL CELL LUNG CANCER Patient information given at each stage following agreed information pathway 1. DIAGNOSIS New
More informationTreatment Algorithms for the Management of Lung Cancer in NSW Guide for Clinicians
Treatment Algorithms for the Management of Lung Cancer in NSW Guide for Clinicians Background The Cancer Institute New South Wales Oncology Group Lung (NSWOG Lung) identified the need for the development
More informationHow To Write Lung Cancer Data Standards For Nhs Scotland
For reference only Do Not Use For more information contact: cdsis@nhs.net Lung Cancer Pathology Data Standards June 2008 National Clinical Dataset Development Programme (NCDDP) Support Team Information
More informationMalignant Mesothelioma
Malignant Mesothelioma What is malignant mesothelioma? Malignant mesothelioma is a cancer that starts in cells in the linings of certain parts of the body, especially in the linings of the chest or abdomen.
More informationGeneral Information About Non-Small Cell Lung Cancer
General Information About Non-Small Cell Lung Cancer Non-small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung. The lungs are a pair of cone-shaped breathing
More informationGeneral Rules SEER Summary Stage 2000. Objectives. What is Staging? 5/8/2014
General Rules SEER Summary Stage 2000 Linda Mulvihill Public Health Advisor NCRA Annual Meeting May 2014 National Center for Chronic Disease Prevention and Health Promotion Division of Cancer Prevention
More informationMalignant Mesothelioma
Malignant Mesothelioma What is malignant mesothelioma? Malignant mesothelioma is a cancer that starts in cells in the linings of certain parts of the body, especially in the linings of the chest or abdomen.
More informationIn Practice Whole Body MR for Visualizing Metastatic Prostate Cancer
In Practice Whole Body MR for Visualizing Metastatic Prostate Cancer Prostate cancer is the second most common cancer in men worldwide, accounting for 15% of all new cancer cases. 1 Great strides have
More informationKidney Cancer OVERVIEW
Kidney Cancer OVERVIEW Kidney cancer is the third most common genitourinary cancer in adults. There are approximately 54,000 new cancer cases each year in the United States, and the incidence of kidney
More informationManagement of Non-Small Cell Lung Cancer Guide for General Practitioners
Management of n-small Cell Lung Cancer Guide for General Practitioners Clinical Stage I Cancer only in one lobe of lung and
More informationBrigham and Women s Hospital, Boston, MA, USA; 2 Verastem, Inc., Boston, MA, USA
Determination of Biomarker Response in a Phase II Window of Opportunity Study of Defactinib (VS 6063), a Focal Adhesion Kinase (FAK) Inhibitor, in Patients with Resectable Malignant Pleural Mesothelioma
More informationUnderstanding Pleural Mesothelioma
Understanding Pleural Mesothelioma UHN Information for patients and families Read this booklet to learn about: What is pleural mesothelioma? What causes it? What are the symptoms? What tests are done to
More informationMedullary Renal Cell Carcinoma Case Report
Bahrain Medical Bulletin, Vol. 27, No. 4, December 2005 Medullary Renal Cell Carcinoma Case Report Mohammed Abdulla Al-Tantawi MBBCH, CABS* Abdul Amir Issa MBBCH, CABS*** Mohammed Abdulla MBBCH, CABS**
More informationLung Cancer: Diagnosis, Staging and Treatment
PATIENT EDUCATION patienteducation.osumc.edu Lung Cancer: Diagnosis, Staging and Treatment Cancer begins in our cells. Cells are the building blocks of our tissues. Tissues make up the organs of the body.
More informationPET/CT in Lung Cancer
PET/CT in Lung Cancer Rodolfo Núñez Miller, M.D. Nuclear Medicine and Diagnostic Imaging Section Division of Human Health International Atomic Energy Agency Vienna, Austria GLOBOCAN 2012 #1 #3 FDG-PET/CT
More informationRadiologic Assessment of Mesothelioma
28 Radiologic Assessment of Mesothelioma Samuel G. Armato III, Heber MacMahon, Geoffrey R. Oxnard, Charles L. Croteau, and Nicholas J. Vogelzang Imaging plays an essential role in the diagnosis, staging,
More informationTreatment of Malignant Pleural Mesothelioma: Is There a Benefit to Pleuropneumonectomy?
55 Treatment of Malignant Pleural Mesothelioma: Is There a Benefit to Pleuropneumonectomy? Stacey Su, Michael T. Jaklitsch, and David J. Sugarbaker Malignant pleural mesothelioma (MPM) is a rare but highly
More informationSurvey of Mesothelioma Associated with Asbestos Exposure in Japan
The research and development and the dissemination projects related to the 13 fields of occupational injuries and illnesses Survey of Mesothelioma Associated with Asbestos Exposure in Japan Clinical characteristics
More informationWhat is Mesothelioma?
What is Mesothelioma? Mesothelioma is a rare type of cancer that develops in the mesothelial cells found in one s body. These cells form membranous linings that surround and protect the body s organs and
More informationMalignant Mesothelioma Versus Metastatic Carcinoma of the Pleura: A CT Challenge
Iran J Radiol. 2016 January; 13(1): e10949. Published online 2015 November 14. CHEST IMAGING DOI: 10.5812/iranjradiol.10949 Research Article Malignant Mesothelioma Versus Metastatic Carcinoma of the Pleura:
More informationThoracoscopy in Pleural Malignant Mesothelioma
Diagnostic and Therapeutic Endoscopy, 1997, Vol. 3, pp. 147-151 Reprints available directly from the publisher Photocopying permitted by license only (C) 1997 OPA (Overseas Publishers Association) Amsterdam
More informationIII. EXTENT OF DISEASE
Advanced Abstracting Lung Cancer III. EXTENT OF DISEASE Staging Systems and Documentation 1 Source: AJCC Cancer Staging Illustrations from the AJCC Cancer Staging Atlas. Springer, 2007. Used with permission.
More informationSurgeons Role in Symptom Management. A/Prof Cliff K. C. Choong Consultant Thoracic Surgeon Latrobe Regional Hospital GIPPSLAND
Surgeons Role in Symptom Management A/Prof Cliff K. C. Choong Consultant Thoracic Surgeon Latrobe Regional Hospital GIPPSLAND Conditions PLEURAL Pleural effusion Pneumothorax ENDOBRONCHIAL Haemoptysis
More informationNon-Small Cell Lung Cancer
Non-Small Cell Lung Cancer About Your Lungs and Lung Cancer How do your lungs work? To understand lung cancer it is helpful to understand your lungs. Your lungs put oxygen into the blood, which the heart
More informationE xtrapleural pneumonectomy has been used in the treatment
Extrapleural Pneumonectomy in the Setting of a Multimodality Approach to Malignant Mesothelioma* David I. Sugarbaker, M.D., F.C.C.P; StevenJ. Mentzei M.D., F.C.C.P; Malcolm DeCamp, M.D.; Thomas j Ljnch,
More informationThe New International Staging System Lung Cancer
The New International Staging System Lung Cancer Valerie W. Rusch, MD Chief, Thoracic Surgery Memorial Sloan-Kettering Cancer Center Chair, Lung and Esophagus Task Force, American Joint Commission on Cancer
More informationMore than 2,500 people are diagnosed with mesothelioma in the UK each year.
This information is an extract from the booklet Understanding mesothelioma. You may find the full booklet helpful. We can send you a free copy see page 5. Contents Introduction Pleural mesothelioma Peritoneal
More informationCharacteristics of Malignant Pleural Mesothelioma in Women
Characteristics of Malignant Pleural Mesothelioma in Women Andrea S. Wolf, MD, MPH, William G. Richards, PhD, Tamara R. Tilleman, MD, PhD, Lucian Chirieac, MD, Shelley Hurwitz, PhD, Raphael Bueno, MD,
More informationStandards and datasets for reporting cancers. Dataset for the histological reporting of mesothelioma. April 2013
Standards and datasets for reporting cancers Dataset for the histological reporting of mesothelioma April 2013 Authors Professor Andrew G Nicholson, Royal Brompton Hospital and Harefield NHS Trust Professor
More informationIntroduction. Case Report
DOI: 10.4046/trd.2009.67.4.369 ISSN: 1738-3536(Print)/2005-6184(Online) Tuberc Respir Dis 2009;67:369-373 CopyrightC2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.
More informationDisease/Illness GUIDE TO ASBESTOS LUNG CANCER. What Is Asbestos Lung Cancer? www.simpsonmillar.co.uk Telephone 0844 858 3200
GUIDE TO ASBESTOS LUNG CANCER What Is Asbestos Lung Cancer? Like tobacco smoking, exposure to asbestos can result in the development of lung cancer. Similarly, the risk of developing asbestos induced lung
More informationA Case of Advanced Malignant Pleural Mesothelioma Treatment with Chemotherapy and Photodynamic Therapy
CASE REPORT http://dx.doi.org/10.4046/trd.2015.78.1.36 ISSN: 1738-3536(Print)/2005-6184(Online) Tuberc Respir Dis 2015;78:36-40 A Case of Advanced Malignant Pleural Mesothelioma Treatment with Chemotherapy
More informationprognostic scoring systems. We
Thorax 2000;55:731 735 731 Original articles Prognostic factors for malignant mesothelioma in 142 patients: validation of CALGB and EORTC prognostic scoring systems J G Edwards, K R Abrams, J N Leverment,
More informationContemporary Management of Malignant Pleural Mesothelioma
Contemporary Management of Malignant Pleural Mesothelioma ERIC G. BUTCHART University Hospital of Wales, Cardiff, United Kingdom Key Words. Mesothelioma Surgery Radiotherapy Chemotherapy Immunology Gene
More informationDiagnosis and Prognosis of Pancreatic Cancer
Main Page Risk Factors Reducing Your Risk Screening Symptoms Diagnosis Treatment Overview Chemotherapy Radiation Therapy Surgical Procedures Lifestyle Changes Managing Side Effects Talking to Your Doctor
More informationPost-recurrence survival in completely resected stage I non-small cell lung cancer with local recurrence
Post- survival in completely resected stage I non-small cell lung cancer with local J-J Hung, 1,2,3 W-H Hsu, 3 C-C Hsieh, 3 B-S Huang, 3 M-H Huang, 3 J-S Liu, 2 Y-C Wu 3 See Editorial, p 185 c A supplementary
More informationMESOTHELIOMA. Not Just a Late Night Commercial. Graciela Hoal, RN, MSN, ACNP-BC
MESOTHELIOMA Not Just a Late Night Commercial Graciela Hoal, RN, MSN, ACNP-BC Saturday Session Thoracic Surgery Nurse Practitioner Greater Los Angeles Veteran Affairs Objectives Course Objectives: Discuss
More informationSurgical therapy of. who should be operated
SAMO Interdisciplinary Workshop on Chest Tumors Lucerne, 13th and 14th January 2012 Surgical therapy of mesothelioma, who should be operated Walter Weder MD Professor of Surgery University Hospital Zurich
More informationSummary of treatment benefits
Risk Management Plan PEMETREXED Powder for concentrate for Solution for infusion Pemetrexed is also indicated as monotherapy for the maintenance treatment of locally advanced or metastatic non small cell
More informationLung Cancer and Mesothelioma
Lung Cancer and Mesothelioma Robert Kratzke, M.D. John C. Skoglund Professor of Lung Cancer Research Section of Heme/Onc/Transplant Department of Medicine University of Minnesota Medical School Malignant
More informationMalignant pleural mesothelioma P/D vs. EPP
3 rd International Thoracic Oncology Congress Dresden, September 13 15, 2012 Malignant pleural mesothelioma P/D vs. EPP Walter Weder, MD Professor of Surgery Dokumentenname Datum Seite 1 Extrapleural Pneumonectomy
More informationHow To Understand How Cancer Works
Mesothelioma Understanding your diagnosis Mesothelioma Understanding your diagnosis When you first hear that you have cancer, you may feel alone and afraid. You may be overwhelmed by the large amount of
More informationMalignant Mesothelioma
Malignant Malignant mesothelioma is a tumour originating from mesothelial cells. 85 95% of mesotheliomas are caused by asbestos exposure. It occurs much more commonly in the chest (malignant pleural mesothelioma)
More informationMalignant Mesothelioma
Malignant mesothelioma is a tumour originating from mesothelial cells. 85 95% of mesotheliomas are caused by asbestos exposure. It occurs much more commonly in the chest (malignant pleural mesothelioma)
More informationMetastatic Renal Cell Carcinoma: Staging and Prognosis of Three Separate Cases.
Metastatic Renal Cell Carcinoma: Staging and Prognosis of Three Separate Cases. Abstract This paper describes the staging, imaging, treatment, and prognosis of renal cell carcinoma. Three case studies
More informationThe Need for Accurate Lung Cancer Staging
The Need for Accurate Lung Cancer Staging Peter Baik, DO Thoracic Surgery Cancer Treatment Centers of America Oklahoma Osteopathic Association 115th Annual Convention Financial Disclosures: None 2 Objectives
More informationTable of Contents. Data Supplement 1: Summary of ASTRO Guideline Statements. Data Supplement 2: Definition of Terms
Definitive and Adjuvant Radiotherapy in Locally Advanced Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation
More informationBreast Cancer. Sometimes cells keep dividing and growing without normal controls, causing an abnormal growth called a tumor.
Breast Cancer Introduction Cancer of the breast is the most common form of cancer that affects women but is no longer the leading cause of cancer deaths. About 1 out of 8 women are diagnosed with breast
More informationLung Carcinoid Tumor
Lung Carcinoid Tumor What are lung carcinoid tumors? Lung carcinoid tumors (also known as lung carcinoids) are a type of lung cancer, which is a cancer that starts in the lungs. Cancer starts when cells
More informationBasic Data. 鍾 XX, female Age:59 y/o
Basic Data 鍾 XX, female Age:59 y/o Chief complain for evaluation of the left pleural mass Clinical course This 59 years old lady Hypertension for 3 years, under herbal control. An episode of high BP up
More information