Pleural mesothelioma: combined modality treatments

Size: px
Start display at page:

Download "Pleural mesothelioma: combined modality treatments"

Transcription

1 DOI: /annonc/mdf663 Pleural mesothelioma: combined modality treatments G. Giaccone Vrije Universiteit Medical Center, Division of Medical Oncology, Amsterdam, The Netherlands Introduction The incidence of malignant mesothelioma (MM) has shown a gradual increase and a variation in the ratio of incidence between genders in Canada, USA, UK and The Netherlands [1 3]. The incidence in Western European countries is expected to reach its peak around the year This is due to the very long latency period (30 40 years) of this type of tumor following asbestos exposure and it appears there are significant differences between the US and several countries in Northern Europe, i.e. the UK and The Netherlands. In the US the annual number of MM cases in males peaked at 2300 cases before the year This is projected to be followed by a drop over the next years towards 500 cases/year. Increasing incidence rates were recorded in the US during the 1970s and 1980s, whereas the annual rate in females has remained stable at 500 cases/year. This discrepancy in the pattern of MM incidence over the years can be explained by the fact that maximum asbestos exposure in the US occurred between 1930 and 1960 whereas in the UK it occurred around 1970 [4]. Malignant pleural mesothelioma tends to remain confined to the hemithorax, and is mainly characterized by locoregional growth and spread. At autopsy, however, as many as 70% of cases have detectable tumor invasion in thoracic lymph nodes, and distant metastases can be observed in liver, lungs, kidney, adrenals and bones in approximately 50% of cases [5]. It is generally believed that the initial growth rate of malignant mesothelioma is slow and that symptoms therefore appear at a late stage. Sometimes a pleuritic effusion is noted which subsides initially but which, after a few years, results in the development of mesothelioma. The tendency of the mesothelioma to grow along the pleural lining first and finally invade adjacent structures such as muscles, ribs and diaphragm makes an early diagnosis difficult. The most frequently reported complaints are pain, shortness of breath and coughing; unexplained fever is also encountered in a number of patients. In the majority of cases there is a pleural effusion which can vary in volume, and a number of patients present with a large exudate which causes compression of the lung and displacement of the mediastinum. The fluid is often a bloody exudate which can suggest a diagnosis of malignant mesothelioma [5]. A more typical feature of the tumor in advanced cases is the retraction of the involved chest side, which occurs following obliteration of the pleural space and encasement of the lung [5]. Growth into the ribs and muscles will lead to localized swelling and pain. The invasion of the mediastinum can result in dysphagia, superior vena cava syndrome and pericardial effusion. When cardiac involvement is present, arrhythmias, non-specific ST-T changes, conducting abnormalities or atrial fibrillation can ensue [6]. Computed tomography (CT) scan or magnetic resonance imaging (MRI) can identify invasion of the mediastinum and diaphragm [7, 8], although MRI has the advantage of saggital images which are informative of the growth of the tumor in the sinuses. Invasion of the heart, pericardium and diaphragm is also discriminated more clearly by MRI than by CT scans. Furthermore, the diaphragm can also be visualized by laparoscopic examination [9]. The use of ultrasound is of help in defining pleural effusions and possible involvement of the heart. Positron emission tomography (PET) scans can be used to differentiate between malignant and benign (fibrotic) tissue and can also indicate whether the tumor is responding to chemotherapy regimens [10]. Gallium scintigraphy is not routinely advocated and could be used in monitoring populations at risk for malignant mesothelioma [11]. The investigation of choice for obtaining tissue for histological diagnosis is a thoracoscopic examination, through which excessive fluid can be drained, followed by pleurodesis, and which facilitates staging. The sensitivity of this procedure is at least 80% [8]. The staging of malignant pleural mesothelioma is difficult and is still an issue of discussion. The best known staging system is the one developed by Butchart [12]. Six other staging systems have been proposed, of which the latest one by the International Mesothelioma Interest Group (IMIG) [IMIG, 1995] is considered to provide the best framework for analyzing all prospective clinical trials. The IMIG staging system has demonstrated the ability of allocating different survival probabilities to different stages [13]. Optimal staging is very important for selection of patients who have localized disease and who may be candidates for surgery or combined modality treatments. The two major histological types of mesothelioma are epithelial and sarcomatoid. Although histology has been recognized as an important prognostic factor for survival in several retrospective series, this is not a general finding and does not have major implications for treatment European Society for Medical Oncology

2 218 Management and prognosis Median survival of patients with MM treated with supportive care alone is approximately 7 months [13]. Surgery The role of surgery is debated. The presence of different staging systems have so far not provided very accurate estimates of prognosis. However, in general, patients with stage I according to Butchart s classification should be considered candidates for radical surgery; these patients have a tumor confined within the capsule of the parietal pleura, involving only the ipsilateral lung, pericardium and diaphragm. The preoperative staging procedures are, unfortunately, rather imprecise. There are two main types of operation which have been employed in patients with malignant pleural mesothelioma: pleurectomy and extrapleural pneumonectomy. Pleurectomy consists of stripping the pleura from the apex of the lung to the diaphragm, along with the pericardium (if necessary). This operation generally requires a thoracotomy. The results of the most representative series published are summarized in Table 1. Operative mortality is only 1 2%, and complications include bronchopleural fistulas, hemorrhage and subcutaneous emphysema. The value of pleural decortication as a palliative measure in case of recurrent effusion has not been well established and might be taken into consideration if pleurodesis fails repeatedly. Extrapleural pneumonectomy is en bloc removal of the parietal pleura, lung, pericardium and hemidiaphragm. Diaphragmatic resection is followed by reconstruction to prevent herniation. In the hands of experienced thoracic surgeons this complex procedure currently has an operative mortality of 5 9%, but serious complications are seen in 25% of patients, which include bronchopleural fistulas and empyema, vocal cord paralysis, chylothorax, arrhythmia and respiratory insufficiency. Extrapleural pneumonectomy is a complex operation, which should be performed by skilled surgeons and in select centers only. The results of the most representative series are summarized in Table 2. The majority of the most recent series report a median survival >1 year. These results should, in the absence of randomized trials, be treated with caution as they could simply be the effect of patient selection. This operation alters the natural history of malignant pleural mesothelioma, as distant metastases are seen more frequently following this operation than following decortication or no surgical treatment [13]. Radiotherapy The role of radiotherapy in the management of malignant pleural mesothelioma is unsettled, although radiotherapy alone probably has no major role to play in this disease. The most recent series do not indicate that irradiation improves survival when compared to best supportive care. The treatment volume is a crucial aspect of radiation of malignant pleural mesothelioma, and treatment of the entire pleura is indicated. This is extremely difficult to achieve without causing serious side effects in normal surrounding tissues, such as the lung, heart and liver. Radical irradiation has delivered Gy to the entire pleural space and the mediastinum, followed by boost irradiation up to Gy to areas of gross disease; until now, however, no satisfactory technique has been developed which allows high-dose radiation without major risks for the adjacent normal tissues. In a recently published study, 5-day continuous infusion of paclitaxel every 3 weeks and 6120 cgy radiation was given to 27 MM patients: this treatment was well tolerated and deserves further evaluation. The recommended paclitaxel dose was 105 mg/m 2 total dose/cycle; however, response and survival in MM patients were not reported in this study [14]. Table 1. Results of pleurectomy Study [reference] Patients Two-year survival (%) Median survival (months) McCormack et al [43] 95 a Law et al [44] Faber 1988 [45] DaValle et al [46] 23 NA 11.2 Wanebo et al [47] 17 epithelial NA sarcomatous NA 11 Achatzy et al [48] Ruffie et al [49] 63 NA 9.8 Brancatisano et al [50] Rusch 1993 [51] a With implant and/or external irradiation. NA, not available.

3 219 Table 2. Results of extrapleural pneumonectomy Study [reference] Patients Two-year survival (%) a Includes patients with pleurectomy. b Multimodality series. NA, not available. Median survival (months) Worn 1974 [52] Bamler and Maassen 1974 [53] NA 23 Butchart et al [12] DeLaria et al [54] 11 NA 15 0 Vogt-Moykopf et al [55] 55 NA Faber 1988 [45] DaValle et al [46] Probst et al [56] 111 a NA Geroulanos et al [57] 18 NA 20 7 Rusch and Venkatraman 1996 [13] Sugarbaker et al b [30] Ruffie et al [49] Operative mortality (%) Radiotherapy is more often used for palliation of pain, or added to surgery in an attempt to improve local control. The results of the published literature are rather difficult to interpret, because radiotherapy was used as part of a multimodality treatment in locally advanced cases of pleural mesothelioma, the small number of patients reported in single studies and because of a lack of randomized trials. In a recent study 47 patients were given 40 Gy followed in some cases by doxorubicin/cyclophosphamide: there were only three responses, and median survival was only 7 months, with a high frequency of pneumonitis [15]. The only available randomized trial of radiotherapy has proven that radiotherapy to the thoracoscopy entry tract significantly reduces the incidence of local relapse: in this study 0/20 patients who received 21 Gy delivered in three fractions days after thoracoscopy had local recurrence, whereas local recurrence developed in 8/20 (40%) patients who did not receive radiation [16]. Chemotherapy A large number of chemotherapeutic agents have been investigated in MM. The level of activity of most agents is poor, and may vary greatly from study to study. Due to the rarity of the disease, phase II studies were usually performed in small numbers of patients especially in the past. Several patients with mesothelioma and sarcomatous histology have in the past been included in soft tissue sarcoma studies and these results are difficult to assess. Extensive reviews of chemotherapy in malignant mesothelioma have recently been published [17, 18]. Because phase II trials have as their major objective the assessment of response rate, measurability of the disease becomes an important issue; in malignant pleural mesothelioma, even by CT scan, it is sometimes difficult to assess exactly disease extension and therefore identify changes during treatment. Disease assessment by chest X-ray is unreliable and this is the major reason for the overestimation of treatment results in older studies. Among single agents studied the anthracyclines doxorubicin and epidoxorubicin, cisplatin and high-dose methotrexate appear to have some consistent degree of efficacy, which is in the range of 10 20% major response rate (Table 3). Although doxorubicin has been considered to be one of the most active agents in this disease, conflicting reports on its activity have been published. Cisplatin, given weekly at 80 mg/m 2 for 6 weeks attained a 36% response rate in 14 patients; however, symptomatic ototoxicity developed in five patients [19]. This study suggests a possible relationship of response with dose intensity of cisplatin. Most antimetabolites have been reported to have some degree of activity, including gemcitabine [20], and its use in combination with other agents may be warranted. Combination chemotherapy does not, so far, appear to yield substantially higher response rates than single agents. The most common combinations contain doxorubicin and cisplatin (Table 4). Although some of these combinations appear to give higher response rates than singe agents, responses are of short duration and complete responses are very rarely observed. In general, none of the published agents or combinations appears to provide any advantage in survival compared with historical controls, although randomized trials against best supportive care have not been conducted. At the 2002 American Society of Clinical Oncology meeting in Orlando an important randomized study was pre-

4 220 Table 3. Systemic single-agent chemotherapy in series with 15 patients Drug Patients Responses Response rate (%) DHAC, 5-dihydro-azacytidine. Reference Doxorubicin Lerner et al [58]; Sorensen et al [59] Detorubicin Colbert et al [60] Pirarubicin Kaukel et al [61] Epirubicin Magri et al [62]; Mattson et al [63] Mitoxantrone Eisenhauer et al [64]; Van Breukelen et al [65] Menogaril Hudis et al [66] Cyclophosphamide Sorensen et al [59] Ifosfamide Alberts et al. 1988b [67]; Zidar et al [68]; Falkson et al [69] Mitomycin Bajorin et al [70] Cisplatin Mintzer et al [71]; Zidar et al [72] Cisplatin Vogelzang et al [21] Carboplatin Mbidde et al [73]; Vogelzang et al [74]; Raghavan et al [75] High-dose methotrexate Solheim et al [76] Trimetrexate Vogelzang et al [77] Edatrexate Belani et al [78]; Belani et al [79] Di-deazafolic acid Cantwell et al [80] 5-Fluorouracil Harvey et al [81] DHAC Vogelzang et al [82]; Dhingra et al [83] Gemcitabine Van Meerbeeck et al [20] Pemetrexed (vitamin supplementation) Shin et al [22] Vincristine Martensson and Sorenson 1989 [84] Vinblastine Cowan et al [85] Vindesine Kelsen et al [86] ; Boutin et al [87] Etoposide Sahmoud et al [88] ; Tammilehto et al [89] Paclitaxel Van Meerbeeck et al [90] Amsacrine Falkson et al [91]; Adams et al [92] Aziridinylbenzoquinone Eagan et al [93] Acivicin Legha and Muggia, 1977 [94] sented. This study is the largest study ever performed on this malignancy and included a total of 448 patients randomized between cisplatin alone and cisplatin plus pemetrexed (ALIMTA) [21]. This study confirmed modest activity of cisplatin alone and demonstrated superiority of the combination in terms of response rate, time to progression and overall survival. Pemetrexed alone has also been tested as a single agent and reported to have a response rate of 16% [22]. Pemetrexed is a novel antimetabolite with multiple mechanisms of action. The use of biological response modifiers also does not appear to be particularly promising, with rather modest response rates by systemic administration of interferons [23]. Combined modality treatment Given the disappointing results of surgery alone, combined modality treatments have been attempted in order to reduce local recurrence and systemic spread. Various modalities have been employed in different institutions. The Memorial Sloan Kettering Cancer Center s experience with pleurectomy, intraoperative brachytherapy and postoperative irradiation was reported about 15 years ago, with a relatively short follow-up, and has not been recently updated [24]. Rusch et al. [25] reported on 36 resectable patients, 28 of whom underwent pleurectomy/decortication, followed by intrapleural chemo-

5 221 Table 4. Combination chemotherapy in series with 15 patients Drugs Patients Responses Response rate (%) DHAC, 5-dihydro-azacytidine; DTIC, dacarbazine. Reference Doxorubicin + cyclophosphamide Samson et al [95] Doxorubicin + cyclophosphamide + DTIC (dacarbazine) Samson et al [95], Dhingra et al [96] Doxorubicin + ifosfamide Carmichael et al [97], Dirix et al [98] Doxorubicin + cisplatin Ardizzoni et al [99], Chahinian et al [100] Doxorubicin + cisplatin + cyclophosphamide Shin et al [101] Doxorubicin + 5-azacytidine Chahinian et al [102] Doxorubicin + interferon-α Upham et al [103] Doxorubicin + cisplatin + mitomycin Pennucci et al [104] Doxorubicin + cisplatin + bleomycin + mitomycin Breau et al [105] Epirubicin + ifosfamide Magri et al [106] Rubidazone + DTIC Zidar et al [107] Pirarubicin + cisplatin Koschel et al [108] Cisplatin + DHAC Samuels et al [109] Cisplatin + vinblastine Tsavaris et al [110] Cisplatin + mitomycin Chahinian et al [100] Cisplatin + mitomycin + interferon-α Tansan et al [111] Cisplatin + interferon-α Soulie et al [112] Cisplatin + pemetrexed Vogelzang et al [21] therapy with cisplatin and mitomycin C and systemic cisplatin and mitomycin C, 3 5 weeks later; median survival was 17 months, and locoregional recurrence developed in 16/20 patients. The authors conclusion was that this cannot be considered as routine treatment. In another study with a similar setup, a median survival of only 11 months was obtained with maximal cytoreduction, radiation and combination chemotherapy [26]. At UCLA 15 patients were treated with pleurectomy/decortication and intrapleural cisplatin and ara C; 46% and 73% received adjuvant chemotherapy and radiotherapy, respectively. Median survival was only 11.5 months. Even though morbidity was very limited in this study, this approach was not recommended routinely by the authors [27]. In another study 19 patients underwent pleurectomy and decortication or pleuropneumonectomy followed by intrapleural cisplatin and mitomycin, followed by systemic cisplatin-based chemotherapy. Postoperative mortality was 5%, with frequent complications. Median survival was 13 months with occasional long-term survivors. Local failure was observed in 58%, distant in 17%, both in 25% [28]. In a controversial report 20 patients with disease limited to one hemithorax underwent subtotal pleurectomy; 13 with preoperative diagnosis underwent perioperative intrapleural cisplatin and cytarabine, followed by systemic cisplatin and mitomycin C. Survival was significantly longer in patients not receiving chemotherapy, and morbidity rates were also higher in these patients [29]. The Dana Farber Cancer Center has a large experience with extrapleural pneumonectomy combined with multi-agent chemotherapy and postoperative radiation. A total of 120 patients were treated from 1980 to 1995 by en bloc extrapleural pneumonectomy followed, 4 6 weeks later, by 4 6 cycles of doxorubicin cyclophosphamide (plus cisplatin after 1985), followed by ipsilateral hemithorax and mediastinum radiotherapy. The operative mortality was 5% with 22% major morbidity rate. The median survival was 21 months with 2- and 5-year survivals of 45% and 22%, respectively. Epithelial cell type and lymph node involvement were the most important prognostic factors in this series. The conclusion of this group was that trimodality treatment is safe and effective for selected patients with malignant pleural mesothelioma without nodal involvement [30, 31]. Sugarbaker et al. [32] also analyzed the pattern of failure of 46 evaluable patients treated by trimodality therapy: 54% recurred, with the sites of recurrence being local in 35%, abdominal in 26%, controlateral in 17% and distant in 8%. Median time to first recurrence was 19 months. This and other studies clearly indicate that more effective strategies should be sought to increase local control. In a study performed at the National Cancer Institute, 36 patients received cisplatin 4 times weekly, interferon-α

6 222 and tamoxifen, for one to five cycles; 10 additional patients had debulking surgery followed by two cycles. Only 19% partial responses were observed with a median survival of 8.7 months [33]. Intracavitary therapy Because mesothelioma of the pleural cavity tends to remain localized for a long time, local treatment with cytotoxic agents or other new approaches may be successful. In a multiinstitutional study 89 patients with stages I and II according to Butchart s classification were treated with intrapleural injections of interferon-γ [34]. Thoracoscopic or surgical biopsy were performed in cases where CT scans revealed a tumor reduction. In total, eight complete responses and nine partial responses were obtained, with an overall response rate of 20%, being 45% in stage I disease and 6% in stage II. Median survival in stage I was 28 months, and 9 months in stage II. According to another report, this treatment might reduce IL-6 production and so reduce symptoms provoked by its production (e.g. fever, cachexia, thrombocytosis) [35]. Four of 21 assessable patients attained partial response by intrapleural IL-2 administration [36] with a median survival of 15.6 months. Intrapleural levels of IL-2 were 6000-fold higher than those observed systemically. The use of radiocolloids, such as 198 Au or 32 P has been investigated by means of instillation into the pleural cavity. However, their use has been rather limited because of the poor ability of these radioisotopes to penetrate tissue, and the reduced diffusion of the radiocolloid into the cavity, in the frequent presence of multiple loculations. A more recent approach to the problem of residual disease after surgery is the use of perioperative photodynamic therapy. The photosensitizer is administered a few days prior to the operation and is retained to some extent in the tumor tissue and vasculature. This treatment modality has been used in a few small studies [37 39]; higher power lasers and improved sensitizers have yielded promising results [40]. The use of suicidal genes in the pleural cavity has recently been the subject of phase I clinical trials [41]. The herpes simplex thymidine kinase gene has been transfected; this gene will convert the normally nontoxic nucleoside analogue ganciclovir into a monophosphorylated form that is then converted by the mammalian thymidine kinase to a triphosphorylated form which is extremely toxic to cells. In animals with an established tumor burden there was a significant prolongation of survival with the use of a replication-restricted Herpes virus to treat experimental human malignant mesothelioma [42]. References 1. Spirtas R, Beebe GW, Connelly RR et al. Recent trends in mesothelioma incidence in the United States. Am J Ind Med 1986; 9: Peto J, Hodgson JT, Matthews FE, Jones JR. Continuing increase in mesothelioma mortality in Britain. Lancet 1995; 345: Burdorf A, Barendregt JJ, Swuste PHJJ, Heederik DJJ. Increasing incidence of mesothelioma in the future by professional exposure to asbestos in the past. Dutch J Med 1997; 141: Price B. Analysis of current trends in United States mesothelioma incidence. Am J Epidemiol 1997; 145: Aisner J. Current approach to malignant mesothelioma of the pleura. Chest 1995; 107: 332S 344S. 6. Wadler S, Chahinian AP, Slater W et al. Cardiac abnormalities in patients with diffuse pleural malignant mesothelioma. Cancer 1986; 58: Patz EF, Shaffer K, Piwnica-Worms DR et al. Malignant pleural mesothelioma: value of CT and MRI imaging in predicting resectability. Am J Resp 1992; 159: Maasilta P, Vehmas T, Kivisaari L et al. Correlations between findings at computer tomography (CT) and at thoracoscopy/thoracotomy/ autopsy in pleural mesothelioma. Eur Resp J 1991; 4: Conlon KC, Rusch VW, Gillern S. Laparoscopy: an important tool in the staging of malignant pleural mesothelioma. Ann Surg Oncol 1996; 3: Bury Th, Paulus P, Dowlati A et al. Evaluation of pleural diseases with FDG-PET imaging: a preliminary report. Thorax 1997; 52: Teirstein AS, Chahinian AP, Goldsmith SJ, Sorek M. Gallium scanning in differentiating malignant from benign asbestos related pleural disease. Am J Ind Med 1986; 9: Butchart EG, Ashcroft T, Barnsley WC, Holden MP. Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Thorax 1976; 31: Rusch VW, Venkatraman E. The importance of surgical staging in the treatment of malignant pleural mesothelioma. J Thorac Cardiovasc Surg 1996; 111: Herscher LL, Hahn SM, Kroog G et al. Phase I study of paclitaxel as a radiation sensitizer in the treatment of mesothelioma and non-small cell lung cancer. J Clin Oncol 1998; 16: Linden C-J, Mercke C, Albrechtsson U et al. Effect of hemithorax irradiation alone or combined with doxorubicin and cyclophosphamide in 47 pleural mesotheliomas: a nonrandomized phase II study. Eur Respir J 1996; 9: Boutin C, Rey F, Viallet J-R. Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma. A randomized trial of local radiotherapy. Chest 1995; 108: Ryan CW, Herndon J, Vogelzang NJ. A review of chemotherapy trials for malignant mesothelioma. Chest 1998; 113: 66S 73S. 18. Baas P, Schouwink H, Zoetmulder FAN. Malignant pleural mesothelioma. A review. Ann Oncol 1998; 9: Planting AS, van der Burg ME, Goey SH et al. Phase II study of a short course of weekly cisplatin combined with long term oral etoposide in pleural mesothelioma. Ann Oncol 1995; 6: Van Meerbeeck J, Baas P, Debruyne C et al. Gemcitabine in malignant pleural mesothelioma: a phase II study. Abstract of the 8th World Conference in Lung Cancer, Dublin, August 10 15, 1997, 17, no Vogelzang NJ, Rusthoven J, Paoletti P et al. Phase III single-blinded study of pemetrexed plus cisplatin versus cisplatin alone in chemonaïve patients with malignant pleural mesothelioma. Proc Am Soc Clin Oncol 2002; 21: 22 (Abstr 5). 22. Shin DM, Scagliotti G, Kindler H et al. A phase II trial of pemetrexed in malignant pleural mesothelioma (MPM) patients: clinical out-

7 223 come, role of vitamin supplementation, respiratory symptoms and lung function. Proc Am Soc Clin Oncol 2002; 21: 2942 (Abstr 1175). 23. Ardizzoni A, Pennucci MC, Castagneto B et al. Recombinant interferon α-2b in the treatment of diffuse malignant pleural mesothelioma. Am J Clin Oncol 1994; 17: Hilaris BS, Dattatreyudu NK, Wong E et al. Pleurectomy and intraoperative brachytherapy and postoperative radiation in the treatment of malignant pleural mesothelioma. Int J Radiat Oncol Biol Phys 1984; 10: 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: Alberts AS, Falkson G, Gaedhals L et al. Malignant pleural mesothelioma: a disease unaffected by current therapeutic maneuvers. J Clin Oncol 1988a; 6: Lee JD, Perez S, Wang HJ et al. Intrapleural chemotherapy for patients with incompletely resected malignant mesothelioma: the UCLA experience. J Surg Oncol 1995; 60: Rice TW, Adelstein DJ, Kirby TJ et al. Aggressive multimodality therapy for malignant pleural mesothelioma. Ann Thorac Surg 1994; 58: Sauter ER, Langer C, Coia LR et al. Optimal management of malignant mesothelioma after subtotal pleurectomy: revisiting the role of intrapleural chemotherapy and postoperative radiation. J Surg Oncol 1995; 60: Sugarbaker DJ, Garcia JP, Richards WG et al. Extrapleural pneumonectomy in the multimodality therapy of malignant pleural mesothelioma. Results in 120 consecutive patients. Ann Surg 1996; 224: Sugarbaker DJ, Garcia J. Multimodality therapy for malignant pleural mesothelioma. Chest 1997; 112: 272S 275S. 32. Baldini EH, Recht A, Strauss GM et al. Patterns of failure after trimodality therapy for malignant pleural mesothelioma. Ann Thorac Surg 1997; 63: Pass HW, Temeck BK, Kranda K et al. A phase II trial investigating primary immunochemotherapy for malignant pleural mesothelioma and the feasibility of adjuvant immunochemotherapy after maximal cytoreduction. Ann Surg Oncol 1995; 2: Boutin C, Nussbaum E, Monnet I et al. Intrapleural treatment with recombinant γ-interferon in early stage malignant pleural mesothelioma. Cancer 1994; 74: Monti G, Jaurand M-C, Monnet I et al. Intrapleural production of interleukin 6 during mesothelioma and its modulation by γ-interferon treatment. Cancer Res 1994; 54: Goey SH, Eggermont AMM, Punt CJA et al. Intrapleural administration of interleukin 2 in pleural mesothelioma: a phase I II study. Br J Cancer 1995; 72: Ris HB, Altermatt HJ, Nachbur B et al. Intraoperative photodynamic therapy with mthpc for chest malignancies. Las Surg Med 1996; 18: Pass HI, Delaney T, Tochner Z et al. Intrapleural photodynamic therapy: results of a phase I trial. Ann Surg Oncol 1994; 1: Takita H, Mang TS, Loewen GM et al. Operation and intracavitary photodynamic therapy for malignant mesothelioma: a phase II study. Ann Thorac Surg 1994; 58: Baas P, Murrer L, Zoetmulder FAN et al. Photodynamic therapy as adjuvant therapy in surgically treated pleural malignancies. Br J Cancer 1997; 76: Albelda SM. Gene therapy for lung cancer and mesothelioma. Chest 1997; 111: 145S 149S. 42. Kucharczuk JC, Randazzo B, Chang MY et al. Use of a replicationrestricted Herpes virus to treat experimental human malignant mesothelioma. Cancer Res 1997; 57: McCormack PM, Nagasaki F, Hilaris BS, Martini N. Surgical treatment of pleural mesothelioma. J Thorac Cardiovasc Surg 1982; 84: Law MR, Gregor A, Hodson ME et al. Malignant mesothelioma of the pleura: a study of 52 treated and 64 untreated patients. Thorax 1984; 39: Faber LP. Surgical treatment of asbestos related disease of the chest. Surg Clin North Am 1988; 68: DaValle MJ, Faber LP, Kittle CF, Jensik RJ. Extrapleural pneumonectomy for diffuse malignant mesothelioma. Ann Thorac Surg 1986; 42: Wanebo HJ, Martini N, Melamed MR et al. Pleural mesothelioma. Cancer 1976; 38: Achatzy R, Beba W, Ritschler R et al. The diagnosis, therapy and prognosis of diffuse malignant mesothelioma. Eur J Cardiothorac Surg 1989; 3: 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: Brancatisano RR, Joseph MG, McCaugham BC. Pleurectomy for mesothelioma. Med J Aust 1991; 154: Rusch VW. Pleurectomy/decortication and adjuvant therapy for malignant mesothelioma. Chest 1993; 103 (Suppl.): 283S 384S. 52. Worn H. Moglichkeiten und ergebnisse der chirurgischen behandlung des malignen pleuramesotheliomas. Thoraxchirurgie 1974; 4: Bamler KJ, Maassen W. Uber die verteilung der benignen und malignen pleuratumoren im krankengut einer lungen-chirurgischen klinik mit besonderer berucksichtigung des maligne pleura mesothelioms und seiner radikalen behandlung einschlisslich der ergibnisse des zwerhfellersatzes mit konservierter dura mater. Thoraxchirurgie 1974; 22: DeLaria GA, Jensik R, Faber LP, Kittle CF. Surgical management of malignant mesothelioma. Ann Thorac Surg 1978; 26: Vogt-Moykopf I, Etspule W, Bulzebruck H. Das diffuse maligne pleuramesotheliom: diagnostik, therapie und prognose. Z Herz Thorac Gefabchir 1987; 1: Probst G, Buelzebruck H, Bauer H et al. The role of pleuropneumonectomy in the treatment of diffuse malignant mesothelioma of the pleura. In Deslauriers J, Laquet LK (eds): Thoracic Surgery: Surgical Management of Pleura Diseases. St Louis: CV Mosby 1990; Geroulanos S, Lampe P, Hafner F et al. Malignant pleural mesothelioma: diagnosis, therapy and prognosis. Schweiz Rundsch Med Prax 1990; 79: Lerner HJ, Schoenfeld DA, Martin A et al. Malignant mesothelioma: the Eastern Cooperative Oncology Group (ECOG) experience. Cancer 1983; 52: Sorensen PG, Bach F, Bork E, Hansen HH. Randomized trial of doxorubicin versus cyclophosphamide in diffuse malignant mesothelioma. Cancer Treat Rep 1985; 69: Colbert N, Vannetzel JM, Israel V et al. A prospective of detorubicin in malignant mesothelioma. Cancer 1985; 56:

8 Kaukel E, Koschel G, Gatzemeier U, Salewski E. A phase II study of pirarubicin in malignant pleural mesothelioma. Cancer 1990; 66: Magri MD, Veronesi A, Foladore S et al. Epirubicin treatment of malignant mesothelioma: a phase II cooperative study. Tumori 1991; 77: Mattson K, Giaccone G, Kirkpatrick A et al. Epirubicin in malignant mesothelioma: a phase II study of the EORTC Lung Cancer Cooperative Group. J Clin Oncol 1992; 10: Eisenhauer EA, Evans WK, Raghavan D et al. Phase II study of mitoxantrone in patients with malignant mesothelioma. A National Cancer Institute of Canada Clinical Trial Group study. Cancer Treat Rep 1986; 70: Van Breukelen FJM, Mattson K, Giaccone G et al. Mitoxantrone in malignant pleural mesothelioma. A study by the EORTC Lung Cancer Cooperative Group. Eur J Cancer 1991; 27: Hudis CA, Kelsen DP. Menogaril in the treatment of malignant mesothelioma: a phase II study. Invest New Drugs 1992; 10: Alberts AS, Falkson G, van Zyl L. Malignant pleural mesothelioma: a phase II pilot study of ifosfamide and mesna. J Natl Cancer Inst 1988b; 80: Zidar BL, Metch B, Balcerzak SP et al. A phase II evaluation of ifosfamide and mesna in unresectable diffuse malignant mesothelioma: a Southwest Oncology Group study. Cancer 1992; 70: Falkson G, Hunt M, Borden EC et al. An extended phase II trial of ifosfamide plus mesna in malignant mesothelioma. Invest New Drugs 1992; 10: Bajorin D, Kelsen D, Mintzer DM. Phase II trial of mitomycin in malignant mesothelioma. Cancer Treat Rep 1987; 71: Mintzer DM, Kelsen D, Frimmer D et al. Phase II trial of high dose cisplatin in patients with malignant mesothelioma. Cancer Treat Rep 1985; 69: Zidar BL, Green S, Pierce HI et al. A phase II evaluation of cisplatin in unresectable diffuse malignant mesothelioma: a Southwest Oncology Group study. Invest New Drugs 1988; 6: Mbidde EK, Harland SJ, Calvert AH, Smith IE. Phase II trial of carboplatin (JM8) in the treatment of patients with malignant mesothelioma. Cancer Chemother Pharmacol 1986; 18: Vogelzang NJ, Goutsou M, Corson JM et al. Carboplatin in malignant mesothelioma: a phase II study of the Cancer and Leukemia Group B. Cancer Chemother Pharmacol 1990; 27: Raghavan D, Gianoutsos P, Bishop J et al. Phase II trial of carboplatin in the management of malignant mesothelioma. J Clin Oncol 1990; 8: Solheim OP, Saeter G, Finnanger AM, Stenwig AE. High dose methotrexate in the treatment of malignant mesothelioma of the pleura. A phase II study. Br J Cancer 1992; 65: Vogelzang NJ, Weissman LB, Herndorn II JE et al. Trimetrexate in malignant mesothelioma: a Cancer and Leukemia Group B phase II study. J Clin Oncol 1994; 12: Belanio CP, Herndon J, Vogelzang NJ et al. Edatrexate for malignant mesothelioma: a phase II study of the Cancer and Leukemia Group B CALGB Proc Am Soc Clin Oncol 1994; 13: 329a (Abstr 1087). 79. Belani CP, Herndon J, Vogelzang NJ et al. Edatrexate with oral leucovorin rescue for malignant mesothelioma: a phase II study of the Cancer and Leukemia Group B, Proc Am Soc Clin Oncol 1995; 14: 352a (Abstr 1068). 80. Cantwell BM, Earnshaw M, Harris AL. Phase II study of a novel antifolate N10-propargyl-5,8 dideazafolic acid (CB3717), in malignant mesothelioma. Cancer Treat Rep 1986; 70: Harvey VJ, Slevin ML, Ponder BA et al. Chemotherapy of diffuse malignant mesothelioma: phase II trials of single agent 5-fluorouracil and adriamycin. Cancer 1984; 54: Vogelzang NJ, Herndon JE, Cirrincione C et al. Dihydro-5-azacytidine in malignant mesothelioma. A phase II trial demonstrating activity accompanied by cardiac toxicity. Cancer 1997; 79: Dhingra HM, Murphy WK, Winn RJ et al. Phase II trial of 5,6-dihydro- 5-azacytidine in pleural malignant mesothelioma. Invest New Drugs 1991; 9: Martensson G, Sorenson S. A phase II study of vincristine in malignant mesothelioma: a negative report. Cancer Chemother Pharmacol 1989; 24: Cowan JD, Green S, Lucas J et al. Phase II trial of five day intravenous infusion vinblastine sulfate in patients with diffuse malignant mesothelioma: a Southwest Oncology Group study. Invest New Drugs 1988; 6: Kelsen D, Gralla R, Cheng E, Martini N. Vindesine in the treatment of malignant mesothelioma; a phase II study. Cancer Treat Rep 1983; 67: Boutin C, Irisson M, Guerin JC et al. Phase II trial of vindesine in malignant pleural mesothelioma. Cancer Treat Rep 1987; 71: Sahmoud T, Postmus PE, van Pottelsberghe Ch et al. Etoposide in malignant pleural mesothelioma; two phase II trials of the EORTC Lung Cancer Cooperative Group. Eur J Cancer 1997; 33: Tammilehto L, Maasilta P, Mantyla M et al. Oral etoposide in the treatment of malignant mesothelioma. A phase II study. Ann Oncol 1994; 5: Van Meerbeeck J, Debruyne C, van Zandwijk N et al. Paclitaxel for malignant pleural mesothelioma: a phase II study of the EORTC Lung Cancer Cooperative Group. Br J Cancer 1996; 74: Falkson G, Vorobiof DA, Lerner HJ. A phase II study of m-amsa in patients with malignant mesothelioma. Cancer Chemother Pharmacol 1983; 11: Adams VI, Unni KK, Muhm JR et al. Diffuse malignant mesothelioma of pleura. Diagnosis and survival in 92 cases. Cancer 1986; 58: Eagan R, Frytak S, Richardson R et al. Phase II trial of diaziquone in malignant mesothelioma. Cancer Treat Rep 1986; 70: Legha SS, Mughia FM. Therapeutic approaches in malignant mesothelioma. Cancer Treat Rev 1977; 4: Samson MK, Wasser LP, Borden EC et al. Randomized comparison of cyclophosphamide, imidazole carboxamide, and adriamycin versus cyclophosphamide and adriamycin in patients with advanced stage malignant mesothelioma: a Sarcoma Intergroup study. J Clin Oncol 1987; 5: Dhingra H, Valdivieso M, Tannir N et al. Combined modality treatment for mesothelioma with cytoxan and adriamycin, and DTIC and adjuvant surgery. Proc Am Soc Clin Oncol 1983; 2: 205a (Abstr C-800). 97. Carmichael J, Cantwell BM, Harris AL. A phase II trial of ifosfamide/mesna with doxorubicin for malignant mesothelioma. Eur J Cancer Clin Oncol 1989; 25: Dirix LY, van Meerbeeck J, Schrijvers D et al. A phase II trial of dose-escalated doxorubicin and ifosfamide/mesna in patients with malignant mesothelioma. Ann Oncol 1994; 5:

9 Ardizzoni A, Rosso R, Salvati F et al. Activity of doxorubicin and cisplatin combination chemotherapy in patients with diffuse malignant pleural mesothelioma. An Italian Lung Cancer Task Force (FONICAP) phase II study. Cancer 1991; 67: Chahinian AP, Antman K, Goutsou M et al. Randomized phase II trial of cisplatin with mitomycin or doxorubicin for malignant mesothelioma by the Cancer and Leukemia Group B. J Clin Oncol 1993; 11: Shin DM, Fossella FV, Umsawasdi T et al. Prospective study of combination chemotherapy with cyclophosphamide, doxorubicin and cisplatin for unresectable or metastatic malignant pleural mesothelioma. Cancer 1995; 76: Chahinian AP, Pajak TF, Holland JF et al. Diffuse malignant mesothelioma. Ann Intern Med 1982; 86: Upham JW, Musk AW, van Hazel G et al. Interferon α and doxorubicin in malignant mesothelioma: a phase II study. Aust NZ J Med 1993; 2316: Pennuci MC, Ardizzoni A, Pronzato P et al. Combined cisplatin, doxorubicin, and mitomycin for the treatment of advanced pleural mesothelioma. A phase II FONICAP trial. Cancer 1997; 54: Breau JL, Boaziz C, Morere JJF et al. Combination chemotherapy with cisplatin, adriamycin, bleomycin and mitomycin C, plus systemic and intrapleural hyaluronidase in 25 consecutive cases of stage II, III pleural mesothelioma. Abstract First International Mesothelioma Conference, Paris, 1991; Magri MD, Foladore S, Veronesi A et al. Treatment of malignant mesothelioma with epirubicin and ifosfamide: a phase II comparative study. Ann Oncol 1992; 3: Zidar BL, Benjamin RS, Frank J et al. Combination chemotherapy for advanced sarcomas of bone and mesothelioma utilizing rubidazone and DTIC: a Southwest Oncology Group study. Am J Clin Oncol 1983; 6: Koschel G, Calavrezos A, Kaukel E et al. Phase III randomized comparison of pirarubicin versus pirarubicin and cisplatin for treatment of pleural mesotheliomas. Proc Sixth European Congress Against Cancer Samuels BL, Herdon II JE, Harmon DC et al. Dihydro-5-azacytidine and cisplatin in the treatment of malignant mesothelioma. A phase II study of the Cancer and Leukemia Group B. Cancer 1998; 82: Tsavaris N, Mylonakis N, Karvounis N et al. Combination chemotherapy with cisplatin vinblastine in malignant mesothelioma. Lung Cancer 1994; 11: Tansan S, Emri S, Selcuk T et al. Treatment of malignant pleural mesothelioma with cisplatin, mitomycin C and α interferon. Oncology 1994; 51: Soulie P, Ruffie P, Trandafir L et al. Combined systemic chemoimmunotherapy in advanced diffuse malignant mesothelioma: report of a phase I II study of weekly cisplatin/interferon α-2a. J Clin Oncol 1996; 14:

10

Mesothelioma. Malignant Pleural Mesothelioma

Mesothelioma. 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 information

بسم هللا الرحمن الرحيم

بسم 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 information

Surgical Management of Malignant Pleural Mesothelioma: A Clinical Practice Guideline

Surgical 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 information

Extrapleural Pneumonectomy for Malignant Mesothelioma: Pro. Joon H. Lee 9/17/2012

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 information

Malignant 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 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 information

Objectives. Mylene T. Truong, MD. Malignant Pleural Mesothelioma Background

Objectives. 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 information

Treatment of mesothelioma in Bloemfontein, South Africa

Treatment 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 information

Malignant Mesothelioma State of the Art

Malignant Mesothelioma State of the Art Malignant Mesothelioma State of the Art Paul Baas The Netherlands Cancer Institute August 12, 2011, Carlsbad, CA Summary Diagnosis; epithelial type subdivided Pleiomorphic vs other Staging: IASLC-IMIG

More information

Malignant pleural mesothelioma: outcome of limited surgical management

Malignant 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 information

Treatment of Mesothelioma with Radiotherapy

Treatment of Mesothelioma with Radiotherapy 41 Treatment of Mesothelioma with Radiotherapy Ryan P. Smith and Stephen M. Hahn General Principles of Radiation Therapy Radiation therapy is a therapeutic modality that uses ionizing radiation to treat

More information

Post-operative intrapleural chemotherapy for mesothelioma

Post-operative intrapleural chemotherapy for mesothelioma Post-operative intrapleural chemotherapy for mesothelioma Robert Kratzke, MD John Skoglund Chair for Lung Cancer Research Section of Heme-Onc-Transplant University of Minnesota Medical School Efficacy

More information

Good symptom relief with palliative MVP (mitomycin-c, vinblastine and cisplatin) chemotherapy in malignant mesothelioma

Good symptom relief with palliative MVP (mitomycin-c, vinblastine and cisplatin) chemotherapy in malignant mesothelioma Annals of Oncology 9: 9-7, 998. 998 Khmer Academic Publishers. Printed in the Netherlands Original article Good symptom relief with palliative MVP (mitomycin-c, vinblastine and cisplatin) chemotherapy

More information

Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma

Accelerated 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 information

Malignant Pleural Mesothelioma in Singapore

Malignant 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 information

Mesothelioma. 1. Introduction. 1.1 General Information and Aetiology

Mesothelioma. 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 information

A Case of Advanced Malignant Pleural Mesothelioma Treatment with Chemotherapy and Photodynamic Therapy

A 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 information

Sternotomy and removal of the tumor

Sternotomy 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 information

First-Line Chemotherapy for Malignant Pleural Mesothelioma

First-Line Chemotherapy for Malignant Pleural Mesothelioma 39 First-Line Chemotherapy for Malignant Pleural Mesothelioma Pasi A. Jänne The Impact of Systemic Chemotherapy The true impact of systemic chemotherapy in mesothelioma has been difficult to evaluate because

More information

Report on New Patented Drugs - Alimta

Report on New Patented Drugs - Alimta Report on New Patented Drugs - Alimta Under its transparency initiative, the PMPRB publishes the results of the reviews of new patented drugs by Board Staff, for purposes of applying the PMPRB s Excessive

More information

Scottish Medicines Consortium

Scottish Medicines Consortium Scottish Medicines Consortium pemetrexed 500mg infusion (Alimta ) No. (192/05) Eli Lilly 8 July 2005 The Scottish Medicines Consortium has completed its assessment of the above product and advises NHS

More information

GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER

GUIDELINES 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 information

Carcinoma of the vagina is a relatively uncommon disease, affecting only about 2,000 women in

Carcinoma of the vagina is a relatively uncommon disease, affecting only about 2,000 women in EVERYONE S GUIDE FOR CANCER THERAPY Malin Dollinger, MD, Ernest H. Rosenbaum, MD, Margaret Tempero, MD, and Sean Mulvihill, MD 4 th Edition, 2001 Vagina Jeffrey L. Stern, MD Carcinoma of the vagina is

More information

NCCN Non-Small Cell Lung Cancer V.1.2011 Update Meeting 07/09/10

NCCN Non-Small Cell Lung Cancer V.1.2011 Update Meeting 07/09/10 Guideline Page and Request NSCL-3 Stage IA, margins positive delete the recommendation for chemoradiation. Stage IB, IIA, margins positive delete the recommendation for chemoradiation + Stage IIA, Stage

More information

Principal Investigator: Valerie W. Rusch, MD, FACS, Chief, Thoracic Surgery Memorial Sloan-Kettering Cancer Center

Principal 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 information

L Lang-Lazdunski, A Bille, S Marshall, R Lal, D Landau, J Spicer

L Lang-Lazdunski, A Bille, S Marshall, R Lal, D Landau, J Spicer Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine and systemic chemotherapy in malignant pleural mesothelioma. A 10-year experience. L Lang-Lazdunski, A Bille, S Marshall, R Lal,

More information

Surgical therapy of. who should be operated

Surgical 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 information

Small Cell Lung Cancer

Small 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 information

Malignant pleural mesothelioma P/D vs. EPP

Malignant 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 information

Clinical Indications and Results Following Chest Wall Resection

Clinical 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 information

Ahmed Farouk Abd El-Hafez, MD

Ahmed 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 information

SMALL CELL LUNG CANCER

SMALL 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 information

Second-Line Chemotherapy

Second-Line Chemotherapy 40 Second-Line Chemotherapy Nick Pavlakis and Nicholas J. Vogelzang Chemotherapy trials for malignant pleural mesothelioma have almost exclusively focused on chemotherapy-naive patients. Until 2000, the

More information

MesoPDT. Photodynamic Therapy for malignant pleural mesothelioma ONCO-THAI. Image Assisted Laser Therapy for Oncology

MesoPDT. Photodynamic Therapy for malignant pleural mesothelioma ONCO-THAI. Image Assisted Laser Therapy for Oncology MesoPDT Photodynamic Therapy for malignant pleural mesothelioma ONCO-THAI Image Assisted Laser Therapy for Oncology Unité Inserm ONCO-THAI «Image Assisted Laser Therapy for Oncology» Inserm ONCO-THAI "Image

More information

Malignant Mesothelioma

Malignant 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 information

Malignant Mesothelioma

Malignant 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 information

treated and 64 untreated patients

treated and 64 untreated patients Thorax 1984;39:255-259 Malignant mesothelioma of the pleura: a study of 52 treated and 64 untreated patients MR LAW, ANNA GREGOR, MARGARET E HODSON, HJG BLOOM, M TURNER-WARWICK From the Cardiothoracic

More information

Malignant Mesothelioma: an Update

Malignant Mesothelioma: an Update Malignant Mesothelioma: an Update Nico van Zandwijk Asbestos Diseases Research Institute Bernie Banton Centre University of Sydney Australia Physicians Week RACP 19-5-2009 Health Risks of Asbestos Fibers

More information

MALIGNANT MESOTHELIOMA is an aggressive

MALIGNANT MESOTHELIOMA is an aggressive Cisplatin and Gemcitabine Treatment for Malignant Mesothelioma: A Phase II Study By M.J. Byrne, J.A. Davidson, A.W. Musk, J. Dewar, G. van Hazel, M. Buck, N.H. de Klerk, and B.W.S. Robinson Purpose: We

More information

MESOTHELIOMA. 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 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 information

prognostic scoring systems. We

prognostic 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 information

Mesothelioma of the Pleura*

Mesothelioma of the Pleura* Current Approach to Malignant Mesothelioma of the Pleura* Joseph Aisner, MD Malignant mesothelioma of the pleura occurs primarily in individuals who were exposed to asbestos either in the workplace or

More information

Treatment of Malignant Pleural Mesothelioma: Is There a Benefit to Pleuropneumonectomy?

Treatment 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 information

Columbia University Mesothelioma Applied Research Foundation - 2009 - www.curemeso.org. Mesothelioma Center www.mesocenter.org

Columbia University Mesothelioma Applied Research Foundation - 2009 - www.curemeso.org. Mesothelioma Center www.mesocenter.org Columbia University Mesothelioma Center www.mesocenter.org Multimodal clinical trials, treatment (surgery, radiation, chemotherapy) Peritoneal mesothelioma program Immunotherapy translational, experimental

More information

Research Article Malignant Pleural Mesothelioma Outcomes in the Era of Combined Platinum and Folate Antimetabolite Chemotherapy

Research Article Malignant Pleural Mesothelioma Outcomes in the Era of Combined Platinum and Folate Antimetabolite Chemotherapy Lung Cancer International Volume 2015, Article ID 590148, 7 pages http://dx.doi.org/10.1155/2015/590148 Research Article Malignant Pleural Mesothelioma Outcomes in the Era of Combined Platinum and Folate

More information

Activity of chemotherapy and immunotherapy on malignant mesothelioma: a systematic review of the literature with meta-analysis

Activity of chemotherapy and immunotherapy on malignant mesothelioma: a systematic review of the literature with meta-analysis Cancer Therapy Vol 1, page 245 Cancer Therapy Vol 1, 245-256, 2003. Activity of chemotherapy and immunotherapy on malignant mesothelioma: a systematic review of the literature with meta-analysis Research

More information

J Clin Oncol 24:3007-3012. 2006 by American Society of Clinical Oncology INTRODUCTION

J Clin Oncol 24:3007-3012. 2006 by American Society of Clinical Oncology INTRODUCTION VOLUME 24 NUMBER 19 JULY 1 2006 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Progression-Free Survival Rate As Primary End Point for Phase II Cancer Clinical Trials: Application to Mesothelioma

More information

Multimodality Therapy of Malignant Pleural Mesothelioma Results in 120 Consecutive Patients

Multimodality 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 information

Stage IIIB disease includes patients with T4 tumors,

Stage IIIB disease includes patients with T4 tumors, Guidelines on Treatment of Stage IIIB Non-small Cell Lung Cancer* James R. Jett, MD, FCCP; Walter J. Scott, MD, FCCP; M. Patricia Rivera MD, FCCP; and William T. Sause, MD, FACR Stage IIIB includes patients

More information

Surgical Management of Malignant Pleural Mesothelioma: A Clinical Practice Guideline

Surgical 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 information

Uterine sarcomas are very rare. They are responsible for only 1 to 5 percent of all malignancies

Uterine sarcomas are very rare. They are responsible for only 1 to 5 percent of all malignancies EVERYONE S GUIDE FOR CANCER THERAPY Malin Dollinger, MD, Ernest H. Rosenbaum, MD, Margaret Tempero, MD, and Sean Mulvihill, MD 4 th Edition 2001 Uterus: Uterine Sarcomas Jeffrey L. Stern, MD Uterine sarcomas

More information

Treating Mesothelioma - A Quick Guide

Treating Mesothelioma - A Quick Guide Treating Mesothelioma - A Quick Guide Contents This is a brief summary of the information on Treating mesothelioma from CancerHelp UK. You will find more detailed information on the website. In this information

More information

Mesothelioma. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com ocft0101 Last reviewed: 03/21/2013 1

Mesothelioma. 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 information

Multidisciplinary discussion of: Early staged NSCLC

Multidisciplinary discussion of: Early staged NSCLC Multidisciplinary discussion of: Early staged NSCLC 2 different classes of patients Stage IIIA pt2pn2 Stage IIB pt3pn0 2 different classes of patients 50% 40% 30% 20% 10% 3y survival 50% 40% 30% 20% 10%

More information

Clinical 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 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 information

Radical surgery for malignant pleural mesothelioma: results and prognosis

Radical surgery for malignant pleural mesothelioma: results and prognosis doi:10.1510/icvts.2007.166322 Interactive CardioVascular and Thoracic Surgery 7 (2008) 102 106 www.icvts.org Institutional report - Thoracic general Radical surgery for malignant pleural mesothelioma:

More information

Population-based survival for malignant mesothelioma after introduction of novel chemotherapy

Population-based survival for malignant mesothelioma after introduction of novel chemotherapy Eur Respir J 2012; 40: 185 189 DOI: 10.1183/09031936.00153611 CopyrightßERS 2012 Population-based survival for malignant mesothelioma after introduction of novel chemotherapy Ronald A.M. Damhuis*, Caroline

More information

Mesothelioma: Questions and Answers

Mesothelioma: 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 information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS 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 information

Chemotherapy for malignant pleural mesothelioma: past results and recent developments

Chemotherapy for malignant pleural mesothelioma: past results and recent developments British Journal of Cancer (2003) 88, 167 174 All rights reserved 0007 0920/03 $25.00 www.bjcancer.com Review : past results and recent developments S Tomek*,1, S Emri 2, K Krejcy 3 and C Manegold 4 1 Department

More information

P L E U R A L M E S O T H E L I O M A

P L E U R A L M E S O T H E L I O M A For media outside the US, UK and Canada only P L E U R A L M E S O T H E L I O M A 1. Overview 2. What is pleural mesothelioma? 3. How common is pleural mesothelioma? 4. What are the risk factors for pleural

More information

Management of mesothelioma

Management of mesothelioma Management of mesothelioma Jan.vanmeerbeeck@ugent.be Amsterdam, March 6, 2010 1 management Palliation Symptomatic care Pain Breathlessness Radiotherapy Chemotherapy Surgery Radical (intention to cure)

More information

Summary of treatment benefits

Summary 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 information

FATAL PNEUMONITIS ASSOCIATED WITH INTENSITY-MODULATED RADIATION THERAPY FOR MESOTHELIOMA

FATAL PNEUMONITIS ASSOCIATED WITH INTENSITY-MODULATED RADIATION THERAPY FOR MESOTHELIOMA RAPID COMMUNICATION FATAL PNEUMONITIS ASSOCIATED WITH INTENSITY-MODULATED RADIATION THERAPY FOR MESOTHELIOMA AARON M. ALLEN, M.D.,* MARIA CZERMINSKA, M.S.,* PASI A. JÄNNE, M.D., PH.D., DAVID J. SUGARBAKER,

More information

The Proposed New International TNM Staging System for Malignant Pleural Mesothelioma: Application to Imaging

The Proposed New International TNM Staging System for Malignant Pleural Mesothelioma: Application to Imaging 323.....:. #{149} :. #{149}..: #{149}. #{149}. :- : Received June 22, 1995; accepted after revision September 12, 1995. 1 Department of Radiology, Duke University Medical Center, Box 3808, Dunham, NC 2771

More information

Mesothelioma and Radical Multimodality Therapy: Who Benefits?*

Mesothelioma and Radical Multimodality Therapy: Who Benefits?* Mesothelioma and Radical Multimodality Therapy: Who Benefits?* David J. Sugarbaker, MD, FCCP; Michael T. Jaklitsch, MD; and Michael J. Liptay, MD The incidence of malignant pleural mesothelioma is increasing.

More information

Lung Cancer: Practical Application of Imaging In Determining Resectability. Jeremy J. Erasmus, M. D.

Lung Cancer: Practical Application of Imaging In Determining Resectability. Jeremy J. Erasmus, M. D. Lung Cancer: Practical Application of Imaging In Determining Resectability Jeremy J. Erasmus, M. D. 62 year old man with a superior sulcus tumor. Which of the following precludes surgical resection in

More information

Round Table with Drs. Anne Tsao and Alex Farivar, Case 2: Mesothelioma

Round 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 information

PET/CT Imaging in Lung Cancer

PET/CT Imaging in Lung Cancer PET/CT Imaging in Lung Cancer Mylene T. Truong, MD Mylene T. Truong M.D. Objectives To discuss the role of PET/CT in the staging of lung cancer To review the recommendations from American Society of Clinical

More information

Analysis of the effect of radiotherapy on malignant pleural mesothelioma when given on adjuvant or palliative basis

Analysis of the effect of radiotherapy on malignant pleural mesothelioma when given on adjuvant or palliative basis Analysis of the effect of radiotherapy on malignant pleural mesothelioma when given on adjuvant or palliative basis Hesham A. El Hossieny, MD 1, Fatma Aboulkasem, MD 2, Abdel Rahman M.,MD 3. (1) Department

More information

Induction of Apoptosis by Intrapleural Perfusion Hyperthermo-Chemotherapy for Malignant Pleural Mesothelioma

Induction of Apoptosis by Intrapleural Perfusion Hyperthermo-Chemotherapy for Malignant Pleural Mesothelioma Original Article Induction of Apoptosis by Intrapleural Perfusion Hyperthermo-Chemotherapy for Malignant Pleural Mesothelioma Yasunori Matsuzaki, MD, Masaki Tomita, MD, Tetsuya Shimizu, MD, Masaki Hara,

More information

PRODYNOV. Targeted Photodynamic Therapy of Ovarian Peritoneal Carcinomatosis ONCO-THAI. Image Assisted Laser Therapy for Oncology

PRODYNOV. Targeted Photodynamic Therapy of Ovarian Peritoneal Carcinomatosis ONCO-THAI. Image Assisted Laser Therapy for Oncology PRODYNOV Targeted Photodynamic Therapy of Ovarian Peritoneal Carcinomatosis ONCO-THAI Image Assisted Laser Therapy for Oncology Inserm ONCO-THAI «Image Assisted Laser Therapy for Oncology» Inserm ONCO-THAI

More information

Surgical treatment for malignant pleural mesothelioma: extrapleural pneumonectomy, pleurectomy/decortication or extended pleurectomy?

Surgical treatment for malignant pleural mesothelioma: extrapleural pneumonectomy, pleurectomy/decortication or extended pleurectomy? JBUON 2015; 20(2): 376-380 ISSN: 1107-0625, online ISSN: 2241-6293 www.jbuon.com E-mail: editorial_office@jbuon.com REVIEW ARTICLE Surgical treatment for malignant pleural mesothelioma: extrapleural pneumonectomy,

More information

Characteristics of Malignant Pleural Mesothelioma in Women

Characteristics 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 information

Table of Contents. Data Supplement 1: Summary of ASTRO Guideline Statements. Data Supplement 2: Definition of Terms

Table 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 information

Screening, early referral and treatment for asbestos related cancer

Screening, 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 information

People Living with Cancer

People Living with Cancer Patient Guide ASCOInformation for People Living with Cancer ADVANCED LUNG CANCER TREATMENT Recommendations of the American Society of Clinical Oncology Welcome The American Society of Clinical Oncology

More information

Disease/Illness GUIDE TO ASBESTOS LUNG CANCER. What Is Asbestos Lung Cancer? www.simpsonmillar.co.uk Telephone 0844 858 3200

Disease/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 information

Surgical Management of Malignant Pleural Mesothelioma

Surgical Management of Malignant Pleural Mesothelioma Evidence-based Series 7-14-2 Version 2 A Quality Initiative of the Program in Evidence-Based Care (PEBC), Cancer Care Ontario (CCO) Surgical Management of Malignant Pleural Mesothelioma Members of the

More information

Protein kinase C alpha expression and resistance to neo-adjuvant gemcitabine-containing chemotherapy in non-small cell lung cancer

Protein kinase C alpha expression and resistance to neo-adjuvant gemcitabine-containing chemotherapy in non-small cell lung cancer Protein kinase C alpha expression and resistance to neo-adjuvant gemcitabine-containing chemotherapy in non-small cell lung cancer Dan Vogl Lay Abstract Early stage non-small cell lung cancer can be cured

More information

Radiation Therapy in the Treatment of

Radiation Therapy in the Treatment of Lung Cancer Radiation Therapy in the Treatment of Lung Cancer JMAJ 46(12): 537 541, 2003 Kazushige HAYAKAWA Professor and Chairman, Department of Radiology, Kitasato University School of Medicine Abstract:

More information

Activity of pemetrexed in thoracic malignancies

Activity of pemetrexed in thoracic malignancies Activity of pemetrexed in thoracic malignancies Results of phase III clinical studies of pemetrexed in malignant pleural mesothelioma and non-small cell lung cancer show benefit P emetrexed (Alimta) is

More information

Small-Cell Lung Cancer: Is There a Standard Therapy?

Small-Cell Lung Cancer: Is There a Standard Therapy? Small-Cell Lung Cancer: Is There a Standard Therapy? Review Article [1] January 02, 1998 By Pieter E. Postmus, MD, PhD [2] and Egbert F. Smit, MD [3] For more than 25 years, chemotherapy has been the cornerstone

More information

Adiuwantowe i neoadiuwantowe leczenie chorych na zaawansowanego raka żołądka

Adiuwantowe i neoadiuwantowe leczenie chorych na zaawansowanego raka żołądka Adiuwantowe i neoadiuwantowe leczenie chorych na zaawansowanego raka żołądka Neoadiuvant and adiuvant therapy for advanced gastric cancer Franco Roviello, IT Neoadjuvant and adjuvant therapy for advanced

More information

Mesothelioma: Treatment and Survival of a Patient Population and Review of the Literature

Mesothelioma: Treatment and Survival of a Patient Population and Review of the Literature Mesothelioma: Treatment and Survival of a Patient Population and Review of the Literature JOHN STATHOPOULOS, DIMOSTHENIS ANTONIOU, GEORGE P. STATHOPOULOS, SOTIRIS K. RIGATOS, JOHN DIMITROULIS, JOHN KOUTANDOS,

More information

1) Thoracic Surgery, Kyoto University Hospital. 2) Radiation Oncology and Image-Applied Therapy, Kyoto University Hospital

1) Thoracic Surgery, Kyoto University Hospital. 2) Radiation Oncology and Image-Applied Therapy, Kyoto University Hospital Title Survival and relapse pattern after malignant pleural mesothelioma. Okubo, Kenichi; Sonobe, Makoto; Fuj Author(s) Tsuyoshi; Sakai, Hiroaki; Miyahara, Hiroshi; Shibuya, Keiko; Hiraoka, M Citation General

More information

It was estimated that 2200 to 3000 new cases of mesothelioma

It was estimated that 2200 to 3000 new cases of mesothelioma RESECTION MARGINS, EXTRAPLEURAL NODAL STATUS, AND CELL TYPE DETERMINE POSTOPERATIVE LONG-TERM SURVIVAL IN TRIMODALITY THERAPY OF MALIGNANT PLEURAL MESOTHELIOMA: RESULTS IN 183 PATIENTS David J. Sugarbaker,

More information

Understanding Pleural Mesothelioma

Understanding 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 information

PET/CT in Lung Cancer

PET/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 information

Avastin: Glossary of key terms

Avastin: Glossary of key terms Avastin: Glossary of key terms Adenocarcinoma Adenoma Adjuvant therapy Angiogenesis Anti-angiogenics Antibody Antigen Avastin (bevacizumab) Benign A form of carcinoma that originates in glandular tissue.

More information

Lung Cancer and Mesothelioma

Lung 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 information

Pre-workshop exercise

Pre-workshop exercise Setting research priorities for mesothelioma workshop 10 th November 2014 Pre-workshop exercise Your individual ranking of unanswered questions about the diagnosis, treatment and care of mesothelioma Please

More information

POLICY A. INDICATIONS

POLICY A. INDICATIONS Alimta (pemetrexed) Line(s) of Business: HMO; PPO; QUEST Integration Akamai Advantage Original Effective Date: 09/01/2007 Current Effective Date: 10/01/2015 POLICY A. INDICATIONS The indications below

More information

Hodgkin Lymphoma Disease Specific Biology and Treatment Options. John Kuruvilla

Hodgkin Lymphoma Disease Specific Biology and Treatment Options. John Kuruvilla Hodgkin Lymphoma Disease Specific Biology and Treatment Options John Kuruvilla My Disclaimer This is where I work Objectives Pathobiology what makes HL different Diagnosis Staging Treatment Philosophy

More information

Contemporary Management of Malignant Pleural Mesothelioma

Contemporary 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 information

Malignant pleural mesothelioma: multidisciplinary experience in a public tertiary hospital*

Malignant pleural mesothelioma: multidisciplinary experience in a public tertiary hospital* 13 Original Article Malignant pleural mesothelioma: multidisciplinary experience in a public tertiary hospital* Ricardo Mingarini Terra 1, Lisete Ribeiro Teixeira 2, Ricardo Beyruti 1, Teresa Yae Takagaki

More information

the standard of care 2009 5/1/2009 Mesothelioma: The standard of care take home messages PILC 2006 Jan.vanmeerbeeck@ugent.be Brussels, March 7, 2009

the standard of care 2009 5/1/2009 Mesothelioma: The standard of care take home messages PILC 2006 Jan.vanmeerbeeck@ugent.be Brussels, March 7, 2009 Mesothelioma: The standard of care Jan.vanmeerbeeck@ugent.be Brussels, March 7, 2009 take home messages PILC 2006 All patients should receive adequate palliation of dyspnea and pain before starting chemotherapy

More information

Evaluation of asbestos-exposure, clinical diagnosis and treatment of MPM

Evaluation of asbestos-exposure, clinical diagnosis and treatment of MPM Evaluation of asbestos-exposure, clinical diagnosis and treatment of MPM Aija Knuuttila, MD, PhD Dept. of Pulmonary Medicine Helsinki University Central Hospital, Finland 15.11.2007 Malignant pleural mesothelioma

More information

Key Words. Mesothelioma Pleural Malignant Treatment Multimodality

Key Words. Mesothelioma Pleural Malignant Treatment Multimodality The Oncologist Lung Cancer Multidisciplinary Treatment of Malignant Pleural Mesothelioma GIOVANNI LUCA CERESOLI, a CESARE GRIDELLI, b ARMANDO SANTORO a a Department of Medical Oncology and Hematology,

More information

The management of malignant pleural mesothelioma; single centre experience in 10 years q

The management of malignant pleural mesothelioma; single centre experience in 10 years q European Journal of Cardio-thoracic Surgery 22 (2002) 298 305 www.elsevier.com/locate/ejcts The management of malignant pleural mesothelioma; single centre experience in 10 years q Tarek Aziz, Ali Jilaihawi,

More information