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

Size: px
Start display at page:

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

Transcription

1 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, PINELOPI MICHALOPOULOU, ATHANASIOS ATHANASIADES and MARINOS VESLEMES SOLCA Study Group and First Department of Medical Oncology, Errikos Dunant Hospital, Athens, Greece Abstract. Background: Our purpose was to evaluate the survival of patients with pleural and intraperitoneal malignant mesothelioma and, particularly, to estimate the efficacy of chemotherapy as well as radiotherapy and surgery. A review of the literature with respect to these parameters is included. Patients and Methods: Thirty-five patients with malignant mesothelioma (28 with pleural and 7 with intraperitoneal) were enrolled. Twenty-eight patients underwent chemotherapy, 7/35 radiation and 9/35 surgery (2 with pleural and 7 with abdominal disease). Combination chemotherapy included cisplatin-gemcitabine, cisplatin (or carboplatin) with premetrexed and doxorubicin-cyclophosphamide. Results: In 2/28 patients with pleural mesothelioma the tumor was excised and in 7 with intraperitoneal disease, surgical therapy was palliative and there was survival prolongation. Radiotherapy was only palliative. Chemotherapy produced a very low response: 2/28 (7.14%) patients achieved a partial response. The median survival was 17 months, 4-year survival, 24.4% and 5-year survival, 12.12%. No serious toxicity was observed. Conclusion: Malignant mesothelioma of the pleura and intraperitoneum is a slow-growing disease which is indicated by the long survival, despite the failure of chemotherapy, radiation therapy and surgery. Mesothelioma is a distinct entity, recognized as such during the 1960s, until which time it had been differentially misdiagnosed as adenocarcinoma (1, 2). It is a rare disease which has been most commonly detected in some geographical regions due to certain environmental influences. The disease involves the pleura and peritoneum and, in rare cases, other sites. The appearance of groups of Correspondence to: G.P. Stathopoulos, MD, Semitelou 2A, Athens, Greece. Tel: , Fax: , Key Words: Mesothelioma, chemotherapy, survival. patients with mesothelioma, who were or had been working in certain occupations, contributed to the definition of the disease (3). The causal relationship between the disease and asbestos in workers in South African mines and, eventually, in other areas, was gradually established (4-7). The differential diagnosis between mesothelioma and lung cancer with pleural effusion was the main difficulty in the past and occasionally still is. The primary site of the disease is mainly the pleura, less commonly the peritoneum and rarely the pericardium. The disease is considered to be malignant but there have been cases classified as benign, which may account for one-third of the diagnosed cases. Some benign conditions, such as fibrous tumor of the pleura and mesothelioma of the atrioventricular node, are not to be confused with malignant mesothelioma. These are histologically and clinically very different benign conditions and the term mesothelioma is a misnomer (8, 9). Apart from the three main mesothelioma locations, other very rare sites are the vagina, testicles, scrotum, sinus and heart ventricles, mediastinum, liver and adrenal glands (9). The discrimination between malignant and benign is pathological. The patient s age is commonly years. Benign disease is also characterized as adenomatoid tumor (10). Malignant mesothelioma is considered by some authors to be a highly symptomatic and rapidly progressive malignancy (11). The great majority of the published data is related to mesothelioma of the pleura. Treatment effectiveness is very poor when the disease is inoperable, although there are exceptions to the rule. In the present article, we review the literature and present our experience in a specific patient population. Our objectives were to evaluate the disease, survival and treatment effectiveness. Patients and Methods Patient eligibility was based on histological confirmation of the diagnosis, and all ages of patients and stages of disease were included. Patients had to have bidimensionally measurable or /2005 $

2 evaluable disease and patients that were eligible for treatment (chemotherapy, surgery or even radiotherapy) had to have a World Health Organisation (WHO) performance status of 0-2 and a life expectancy of at least 3 months. Also, patients were required to have adequate bone marrow reserves (granulocyte count 1,500/dl, platelet count 120,000/dl), normal renal (serum creatinine concentration <1.2 mg/dl) and liver function tests (total serum bilirubin concentration <3 mg/dl, provided that serum transaminases and serum proteins were normal), normal cardiac function with no history of clinically unstable angina pectoris or myocardial infarction, or congestive heart failure within the previous 6 months, and no central nervous system involvement. Patients with active infection, malnutrition or a second primary tumor (except for a non-melanoma skin epithelioma or in situ cervix carcinoma) were excluded. Evaluation of patients. Patient evaluation included complete medical history and physical examination, full blood count including differential leukocyte and platelet counts, a standard biochemical profile (and creatinine clearance when necessary), electrocardiogram, chest X-ray and computed tomography (CT) scans of the chest and upper and lower abdomen. Additional imaging studies were performed upon clinical indication. In patients who underwent chemotherapy, a full blood count with differential was performed weekly. Treatment. The treatment plan was to include surgery, radiation therapy and chemotherapy on the basis of disease location and stage. All patients with abdominal mesothelioma were designated for surgery, although in this location the surgical procedure is mainly of a palliative nature, aiming at cytoreduction. In pleural mesothelioma, surgery should be performed only in earlyoperable stages. Radiation therapy was planned only in inoperable cases of pleural mesothelioma, for pain relief and possible cytoreduction. Pleurodesis with bleomycin or talc was very selectively decided upon for pleural effusion reduction. Chemotherapy does not bring about major response but it has a place, mainly as a palliative treatment, rendering clinical benefit in a percentage of patients. Three different chemotherapy schedules were given: a) cisplatin 80 mg/m 2 combined with gemcitabine 1 g/m 2, repeated every 3 weeks and in some patients (with reasonable bone marrow tolerance) gemcitabine was also given on day 8; b) doxorubicin 50 mg/m 2 and cyclophosphamide 500 mg/m 2 plus or minus vincristine 1.2 mg/m 2 or vinblastine 6 mg/m 2, every 3 weeks and, c) cisplatin 80 mg/m 2 or carboplatin 6 AUC with premetrexed 500 mg/m 2 every 3 weeks. Two patients received carboplatin 6 AUC and paclitaxel 175 mg/m 2 every 3 weeks. Some patients underwent second-line chemotherapy either with gemcitabine 1 g/m 2 alone or with irinotecan 135 mg/m 2 and oxaliplatin 135 mg/m 2 every 3 weeks. Out of the 35 patients, 9 were treated by surgery either as a firstline treatment or after chemotherapy; 7 of the 9 patients had abdominal mesothelioma and 2 pleural. Seven patients with pleural disease were treated with radiotherapy (30-40 Gy). Two patients had early-stage pleurodesis. Twenty-eight patients were treated with chemotherapy: 12 with cisplatin-gemcitabine, 6 with doxorubicin-cyclophosphamide, 3 with gemcitabine as single-agent chemotherapy, 5 with cisplatin (or carboplatin) combined with premetrexed and 2 patients received irinotecan-oxaliplatin as second-line treatment. Table I. Patients characteristics. Definition of response. Complete response (CR) was defined as the disappearance of all measurable or evaluable disease, signs and symptoms and biochemical changes related to the tumor for at least 4 weeks, during which time no new lesions may appear. Partial response (PR) was defined as >50% reduction in the sum of the products of the perpendicular diameters of all measurable lesions compared with pretreatment measurements, lasting for at least 4 weeks, during which time no new lesions may appear and no existing lesions may enlarge. Stable disease (SD) was defined as <50% reduction or a <25% increase in the sum of the products of the two perpendicular diameters of all measured lesions and the appearance of no new lesions for 8 weeks. Progressive disease (PD) was defined as an increase in the product of the two perpendicular diameters of any measurable lesion by >25% over the size present at entry into the study treatment, or, for patients who responded, the size at the time of maximum regression and the appearance of new areas of malignant disease. A two-step deterioration in performance status, a >10% loss in pretreatment weight or increasing symptoms did not, by themselves, constitute progression of the disease; however, the appearance of these complaints was followed by a new evaluation of the extent of the disease. All responses had to be maintained for at least 4 weeks and be confirmed by an independent panel of radiologists. Statistics. Survival distribution was estimated by the Kaplan-Meier method. Results No. % Patients enrolled Age (yr) Median 60 Range Gender Male Female Performance status (WHO) Disease stage I II III Histology-Mesothelioma Epithelial Papillary Fibrosarcomatous Primary site Pleura Pericardium (metastasis from pleura) (2) (5.71) Abdomen (omentum) In this study, the patients, who were of multicenter origin, were enrolled, analyzed and evaluated over the past 8 years; 3672

3 Stathopoulos et al: Treatment and Survival of Patients with Mesothelioma Figure 1. Kaplan-Meier overall survival. the median follow-up was 4 years, range 1-8 years. The patients characteristics are shown in Table I: median age 60 years (range years), WHO performance status of 0, 1 and 2 in 2, 22, and 11 patients, respectively. Twenty-eight patients had primary disease in the pleura and 7 in the abdomen. Two patients had advanced disease in the pericardium and 2, metastases (extension) from the pleura to the abdomen. All patients had histological confirmation of malignant mesothelioma based on biopsy specimens. Twelve patients with pleural disease were cytologically diagnosed. Thirty-three patients had histologically-confirmed malignant mesothelioma of the epithelial type, 1, the fibrosarcomatous type and 1, the papillary type; in 5 patients, the differentiation was high, while in the others, it was low. Compliance with treatment. A total of 168 chemotherapy cycles were administered with a median of 6 cycles per patient (range 2-15). The median interval between cycles was 21 days (range 7-28). Thirty-two cycles (19.05%) were delayed due to either hematological toxicity (20 cycles) or to non-hematological toxicity (asthenia, GI tract toxicity). The median time of delay was 7 days (range 5-14). At the time of analysis, 4 patients were still alive (11.43%) and 31 were dead (88.57%). The cause of death was the disease in 34 patients (97.14%) and acute leukemia (second primary) in 1. Response to treatment and survival. Responses were analyzed on an intention-to-treat basis. Out of 35 patients, 9 underwent surgical treatment; 2 (5.71%) of these patients had a pneumonectomy with complete remission of the disease: 1 patient showed recurrence in 6 months and the other in 3 years. Seven (20%) patients with abdominal disease achieved partial remission and the time to tumor progression (TTP) was median 6 months (range 3-12 months). Of the 7 patients with the tumor in the pleura who had undergone radiotherapy, no complete or partial remission was observed. In 5 out of these 7 patients, there was only clinical benefit (pain relief). Of the 28 patients who had chemotherapy, 2 (7.14%) patients achieved a partial response; 1 of these patients was treated with cisplatin and gemzar and the other with cisplatin and premetrexed. TTP was 6 months for the former patient and 12 months for the latter. Twenty-one/28 (75%) had stable disease and 5/28 had disease progression (17.86%). The median survival was 17 months, range 1-96 months (95% CI ). Figure 1 shows the overall survival. Toxicity. Chemotherapy treatment was accompanied by acceptable toxicity. Myelotoxicity with grade 3-4 neutropenia was observed in 2 (7.14%) patients, grade 2 anemia in 9 (32.14%) and grade 2 thrombocytopenia in 1 (3.57%) patient. 3673

4 Review and Discussion From our study of our 35 patients, one could suggest that mesothelioma of either the pleura or the peritoneum is not a rapidly progressive malignancy and this has been reported in the literature (11). Out of 35 patients, only 4 (11.43%) survived from 1-3 months, whereas more than half of the patients survived over a year, and 24.24% and 12.12% survived for 4+ and 5+ years, respectively. A small minority of our patients were treated successfully by surgery, whereas the effectiveness of chemotherapy was almost negligible. Therefore, the extent of survival appears to conform with the natural history of the disease, which permits survival and a reasonable quality of life for some years, despite the failure of chemotherapy and/or radiation therapy. The great majority of studies are related to pleural mesothelioma and very few to the abdominal (intraperitoneal) site of the disease (12). Much data are concerned with the pathogenesis of mesothelioma in relation to asbestos (13-17), even though only in one of our patients was this pathogenic factor confirmed. Although a rare disorder, a higher number of cases of mesothelioma have been reported in certain geographic regions (in contrast to the general population) with factories where asbestos was a dominant factor (13, 17, 18). Mesothelioma is more common in men than women (5:1), usually in the year age range (as was the case in our material), although other age groups can be affected (18). Survival varies substantially and median survival is reported to be 4-18 months, as indicated in several reviews. Nonetheless, survival can range from a few weeks up to 16 years, as has been documented (19); this variation concurs with our data. At diagnosis, it is difficult to classify cases that will be more aggressive than others. Highly symptomatic cases are observed particularly when the disease is advanced and it affects certain anatomical sites (11). There are asymptomatic cases, but symptoms such as cough or pain may be intolerable. The thoracic wall may be affected in 10% of cases, as well as the esophagus, ribs, vertebrae, nerves and upper vena cava, with symptoms such as dysphagia, pain and spinal nervous system compression; Horner s or upper vena cava syndrome may be present. Thrombotic events, such as pulmonary emboli or intraarterial coagulation, are some of the most serious complications (20, 21). The treatment of mesothelioma is often disappointing. Surgical management is considered controversial and doubts about curative surgery have been reported. Failure to achieve long survival after surgery and high surgical or postsurgical mortality, as well as the common recurrence of the disease, have created skepticism about surgical treatment (22). In a large series of 183 patients, 66 of whom had surgical excision with disease-free resection margins, the 2- and 5-year survivals were 68% and 46%, respectively (23). The role of radiotherapy in mesothelioma is very limited with only occasional responses observed; it is considered to be palliative therapy with some symptomatic relief, as observed in our study. Up to Gy is the suggested dosage, which might also serve for large mass reduction. Survival after radiotherapy is not prolonged. In a randomized study where 52 patients received radiation therapy and 64 remained with best supportive care, it was shown that the 2- year survival was 33% in both arms and the 4-year survival, 0% for those treated and 11% for the non-treated (24). Other data suggest that, when radiotherapy is added to the other treatments (surgery-chemotherapy), the dosage variation or technique does not change effectiveness (25, 26). With the difficulties involved in applying surgery and radiotherapy, patient management is concentrated on chemotherapy with cytotoxic agents. A large number of drugs have been tested with three modes of chemotherapy application: single-agent treatment, the combination of drugs intravenously and intracavitary injection of the agents. Alkylating agents, anthracyclines, vinca alkaloids antimetabolites, taxanes, cisplatinum analogs and campto- thecins are used (9). Responses of 3-18% have been observed with single-agent chemotherapy. It has been reported that doxorubicin, cisplatin and antimetabolites (methotrexate, premetrexed) are the most efficacious (27-30). The combination of cytotoxic agents in some trials has shown responses from 0-48% (9). A high response rate of 48%, in a small number of patients, was produced by the combination of cisplatin and gemcitabine, but this has not been confirmed in other trials. Stable disease and clinical benefit have also been described (31). A quite high response rate (44%) was also documented in another trial where cisplatin was combined with bleomycin, adriamycin and mitomycin-c (32). The combination of cisplatin and doxorubicin has produced a 28% response rate (33). Intracavitary infusion of cytotoxic agents has offered some temporary benefit with a repeated number of infusions. In 47 patients, with the combination of cisplatin and cytarabine, a 49% objective response was reported (34). A pharmacokinetic study of intracavitary infusion showed a higher concentration in the pleural fluid than in the plasma (35). Trials with interferon-á and interleukin-2 have also shown some temporary effectiveness in a small percentage of patients (36, 37). Our data concur with the majority of reported data from other trials with respect to response to treatments and survival. In selective cases, neoadjuvant chemotherapy with cisplatin and gemcitabine, which rendered a response rate of 32%, led to extrapleural pneumonectomy in 16 out of 19 patients (38); the median survival was 23 months. This presurgical treatment may offer hope for a better prognosis in some cases of mesothelioma. The survival of patients with malignant mesothelioma following chemotherapy treatment was documented in a 3674

5 Stathopoulos et al: Treatment and Survival of Patients with Mesothelioma recent study: the median survival was 7 months and 1- and 2-year survivals were 31% and 11%, respectively. Patients with a PS of 0-1 had a median survival of 10 months (39). Other researchers have reported that the natural history of the disease may involve aggressive local growth invasion of vital mediastinal structures and death within 4-12 months without treatment (40). Long survival with multi-modality treatment (surgery, radiation and chemotherapy) has been reported in selected cases (41). There is, however, a type of malignant mesothelioma which progresses slowly and patients may be asymptomatic for long periods (42). The present study describes a group of patients with malignant mesothelioma, their response to treatment and survival; this tumor is, for the most part, resistant to chemotherapy and radiotherapy. Surgery can play a palliative role or it can be applied successfully in the early stages of the disease. Although in most of the literature, survival is reported as short, there are patients who do have long survival, as has been documented in other studies as well as ours. References 1 Robertson HE: Endothelioma of the pleura. Cancer Res 8: , Doll R: Mortality from lung cancer in asbestos workers BMJ 12: 81-88, Wagner JC, Sleggs A and Marchand P: Diffuse pleural mesothelioma and asbestos in the North Western Cape Province. Br J Ind Med 17: , Women Inspectors of Factories. Annual Report for Her Majesty s Stationery Office, London, Merewether ERA and Price CV: Report on Effects of Asbestos Dust in the Lungs and Dust Suppression in the Asbestos Industry. Her Majesty s Stationery Office, London, Lynch KM and Smith WA: Pulmonary asbestos III: carcinoma of lung in asbestosilicosis. Am J Cancer 14: 56-62, Gloyne SR: Two cases of squamous carcinoma of the lung occurring in asbestos. Tubercle 17: 5-8, Carbone M, Kratzke RA and Testa JR: Pathogenesis of mesothelioma. Semin Oncol 29: 2-17, Pass HI, Vogelzang NJ, Hahn SM and Carbone M: Benign and malignant mesothelioma. In: Cancer Principles and Practice of Oncology, VII ed. De Vita VT, Hellman S and Rosenberg SA, (eds.). Philadelphia: Lippincott Williams and Wilkins, pp , Davies JH and Netley RG: Adenomatoid tumors of the male genital tract. Review of 5 men presenting with an intrascrotal swelling subsequently diagnosed as an adenomatoid tumor. Eur Urol 16: , Hollen PJ, Gralla RJ and Liepa AM: Adapting the lung cancer symptom scale (LCSS) to mesothelioma using the LCSS-meso conceptual model for validation. Cancer 101: , Weissman L, Osteen R. Corson J et al: Combined modality therapy for intraperitoneal mesothelioma. Proc Am Soc Clin Oncol 7: 274, 1988 (abstr 1063). 13 Anderson HA, Hanraham LP, Schirmer J et al: Mesothelioma among employees with likely contact with in-place asbestoscontaining building materials. Ann NY Acad Sci 643: , Timbrell V: Physical Factors as Etiological Mechanisms in Biological Effects of Asbestos. Int Agency Res Cancer (Lyon) Stanton MF, Layard M, Tegeris A et al: Carcinogenicity of fibrous glass: pleural response in relation to fiber dimension. J Natl Cancer Inst 58: , Heintz NH, Janssen YM and Mossman BT: Persistent induction of c-fox and c-jun expression by asbestos. Proc Natl Acad Sci USA 90: 3299, Suzuki K and Hei TK: Induction of heme oxygenase (HO) in mammalian cells by mineral cells mineral fibers: distinctive effect of reactive oxygen species. Carcinogenesis 17: , Connelly RR, Spirtas R, Myers MH et al: Demographic patterns for mesothelioma in the United States. J Natl Cancer Inst 78: , Antman KH: Malignant mesothelioma. N Engl J Med 303: , De Pangher, Manzini V, Brollo A and Bianchi C: Thrombocytosis in malignant pleural mesothelioma. Tumori 76: , Mc Anley P, Asa SL, Chiu B et al: Parathyroid hormone like peptide in normal and neoplastic mesothelial cells. Cancer 66: , Boutin DJ, Schlesser M, Frenay C and Astoul P: Malignant pleural mesothelioma. Eur Resp J 12: , Sugarbaker DJ, Flores RM, Jacklitsch MT et al: Resection margins extrapleural model status, and all type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg 117: 54-discussion, 63, Law MR, Gregor A, Hodson ME et al: Malignant mesothelioma of the pleura: a study of 52 treated and 64 untreated patients. Thorax 39: , Ball DL and Cruickshank DG: The treatment of malignant mesothelioma of the pleura: review of a 5-year experience, with special reference to radiotherapy. Ann J Clin Oncol 13: 4-10, De Graaf-Strukowska L, Vander Zee J, Van Putten W and Senam S: Factors influencing the outcome of radiotherapy in malignant mesothelioma of the pleura a single institution experience with 189 patients. Int J Radiat. Oncol Biol Phys 43: , Harvey VJ, Slevin ML, Ponder BA et al: Chemotherapy of diffuse malignant mesothelioma: phase II trials of single-agent 5-fluorouracil and adriamycin. Cancer 54: , Planting AS, Schellens JH, Goey SH et al: Weekly high-dose cisplatin in pleural mesothelioma. Ann Oncol 5: , Solheim OP, Saeter G, Finnager AM and Stenwig AE: Highdose methotrexate in the treatment of malignant mesothelioma of the pleura. A phase II study. Br J Cancer 65: , Vogelzang NJ, Weissman LB, Herndon JN et al: Trimetrexate in malignant mesothelioma: a Cancer and Leukemia Group Phase II Study. J Clin Oncol 12: , Byrne MJ, Davidson JA, Musk AW et al: Cisplatin and gemcitabine treatment for malignant mesothelioma: a phase II study. J Clin Oncol 17: 25-30,

6 32 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 stages II, III pleural mesothelioma. Proc 1st International Mesothelioma Conference, Paris 5: Ardizzoni A, Hosso 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 Phase II Study. Cancer 67: , Rusch VW, Piantose S and Holmes EC: The role of extrapleural pneumonectomy in malignant pleural mesothelioma. A Lung Cancer Study Group trial. J Thorac Cardiovasc Surg 102: 1-6, Rusch VW, Niedzwiecki D, Tao Y et al: Intrapleural cisplatin and mitomycin for malignant mesothelioma following pleurectomy: pharmacokinetic studies. J Clin Oncol 10: , Boutin C, Viallat JR, Zandwijk NV et al: Activity of intrapleural recombinant gamma-interferon in early stage malignant pleural mesothelioma. Cancer 74: , Astoul P, Picat-Jovssen D, Viallat JR and Boutin C: Intrapleural administration of interleukin-2 for the treatment of patients with malignant mesothelioma: a phase II study (see comments). Cancer 83: , Weder W, Kestenhelz P, Tarerna C et al: Neoadjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma. J Clin Oncol 22: , Andreopoulou E, Ross PJ, O Brian MER et al: The palliative benefits of MVP (mitomycin C, vinblastine and cisplatin) chemotherapy in patients with malignant mesothelioma. Ann Oncol 15: , Zellas LS and Sugarbaker DJ: Diffuse malignant mesothelioma of the pleural space and its management. Oncology (Huntingt) 16: , Zellas LS and Sugarbaker DJ: Multi-modality treatment of diffuse malignant pleural mesothelioma. Semin Oncol 29: 41-50, Murray P, O Brian MER, Smith IE et al: The natural history of asymptomatic malignant mesothelioma [abstract]. Br J Cancer 85(suppl 1): 70, Received April 13, 2005 Revised May 30, 2005 Accepted June 13,

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

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

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

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

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

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

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

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

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

Gemcitabine, Paclitaxel, and Trastuzumab in Metastatic Breast Cancer

Gemcitabine, Paclitaxel, and Trastuzumab in Metastatic Breast Cancer Gemcitabine, Paclitaxel, and Trastuzumab in Metastatic Breast Cancer Review Article [1] December 01, 2003 By George W. Sledge, Jr, MD [2] Gemcitabine (Gemzar) and paclitaxel show good activity as single

More information

Small Cell Lung Cancer

Small Cell Lung Cancer Small Cell Lung Cancer Lung Practice Guideline Dr. Brian Dingle MSc, MD, FRCPC Approval Date: April 2007 Revised: November 2008 This guideline is a statement of consensus of the Thoracic Disease Site Team

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

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

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

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

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

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

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

Primary -Benign - Malignant Secondary

Primary -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 information

Corso Integrato di Clinica Medica ONCOLOGIA MEDICA AA 2010-2011 LUNG CANCER. VIII. THERAPY. V. SMALL CELL LUNG CANCER Prof.

Corso Integrato di Clinica Medica ONCOLOGIA MEDICA AA 2010-2011 LUNG CANCER. VIII. THERAPY. V. SMALL CELL LUNG CANCER Prof. Corso Integrato di Clinica Medica ONCOLOGIA MEDICA AA 2010-2011 LUNG CANCER. VIII. THERAPY. V. SMALL CELL LUNG CANCER Prof. Alberto Riccardi SMALL CELL LUNG CARCINOMA Summary of treatment approach * limited

More information

Peritoneal Mesothelioma: The Columbia Experience

Peritoneal Mesothelioma: The Columbia Experience 48 Peritoneal Mesothelioma: The Columbia Experience Jennifer A. Wagmiller, Mary-Louise Keohan, John A. Chabot, Karen Fountain, Mary Hesdorffer, and Robert N. Taub Malignant peritoneal mesothelioma is a

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

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

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

Prior Authorization Guideline

Prior Authorization Guideline Prior Authorization Guideline Guideline: PS Inj - Alimta Therapeutic Class: Antineoplastic Agents Therapeutic Sub-Class: Antifolates Client: PS Inj Approval Date: 8/2/2004 Revision Date: 12/5/2006 I. BENEFIT

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

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

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

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

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

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

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

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

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

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

Maintenance chemotherapy or not in ovarian cancer stages IIIA, B, C, and IV after disease recurrence

Maintenance chemotherapy or not in ovarian cancer stages IIIA, B, C, and IV after disease recurrence Journal of BUON 17: 735-739, 2012 2012 Zerbinis Medical Publications. Printed in Greece ORIGINAL ARTICLE Maintenance chemotherapy or not in ovarian cancer stages IIIA, B, C, and IV after disease recurrence

More information

INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER Prospective Mesothelioma Staging Project

INTERNATIONAL 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 information

London Cancer. Mesothelioma Lung Protocols

London Cancer. Mesothelioma Lung Protocols London Cancer Mesothelioma Lung Protocols Version 0.9 Contents 1. Staging... 3 2. Mesothelioma Summary of Chemotherapy Protocols... 4 3. Mesothelioma Chemotherapy Protocols... 7 3.1. Pemetrexed (Alimta

More information

MOH Policy for dispensing NEOPLASTIC DISEASES DRUGS

MOH Policy for dispensing NEOPLASTIC DISEASES DRUGS MOH Policy for dispensing NEOPLASTIC DISEASES DRUGS All prescriptions for antineoplastic drugs must be accompanied by the MOH special form. All the attachments mentioned on this form shall be submitted

More information

Stage I, II Non Small Cell Lung Cancer

Stage I, II Non Small Cell Lung Cancer Stage I, II Non Small Cell Lung Cancer Best Results T1 (less 3 cm) N0 80% 5 year survival No Role Adjuvant Chemotherapy Radiation Therapy Reduces Local Recurrence No Improvement in Survival 1 Staging Mediastinal

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

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

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

Osteosarcoma: treatment beyond surgery

Osteosarcoma: treatment beyond surgery Osteosarcoma: treatment beyond surgery Eric Chow, DVM DACVS Sue Downing, DVM DACVIM-Oncology Providing the best quality care and service for the patient, the client, and the referring veterinarian. Osteosarcoma

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

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

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

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

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

7. Prostate cancer in PSA relapse

7. Prostate cancer in PSA relapse 7. Prostate cancer in PSA relapse A patient with prostate cancer in PSA relapse is one who, having received a primary treatment with intent to cure, has a raised PSA (prostate-specific antigen) level defined

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

LYMPHOMA IN DOGS. Diagnosis/Initial evaluation. Treatment and Prognosis

LYMPHOMA IN DOGS. Diagnosis/Initial evaluation. Treatment and Prognosis LYMPHOMA IN DOGS Lymphoma is a relatively common cancer in dogs. It is a cancer of lymphocytes (a type of white blood cell) and lymphoid tissues. Lymphoid tissue is normally present in many places in the

More information

Is the third-line chemotherapy feasible for non-small cell lung cancer? A retrospective study

Is the third-line chemotherapy feasible for non-small cell lung cancer? A retrospective study Turkish Journal of Cancer Volume 34, No.1, 2004 19 Is the third-line chemotherapy feasible for non-small cell lung cancer? A retrospective study MUSTAFA ÖZDO AN, MUSTAFA SAMUR, HAKAN BOZCUK, ERKAN ÇOBAN,

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

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

Update on Mesothelioma

Update 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 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

The lungs What is lung cancer? How common is it? Risks & symptoms Diagnosis & treatment options

The lungs What is lung cancer? How common is it? Risks & symptoms Diagnosis & treatment options Why We re Here The lungs What is lung cancer? How common is it? Risks & symptoms Diagnosis & treatment options What Are Lungs? What Do They Do? 1 Located in the chest Allow you to breathe Provide oxygen

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

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

Gemcitabine and Cisplatin in Patients With Locally Advanced, Recurrent, or Metastatic Head and Neck Cancer: Results of a Phase II Trial

Gemcitabine and Cisplatin in Patients With Locally Advanced, Recurrent, or Metastatic Head and Neck Cancer: Results of a Phase II Trial Gemcitabine and Cisplatin in Patients With Locally Advanced, Recurrent, or Metastatic Head and Neck Cancer: Results of a Phase II Trial Mouhammed J Kyasa, MD Randall L Breau, MD Ehab Hanna, MD James Suen,

More information

Surgery. Wedge resection only part of the lung, not. not a lobe, is removed. Cancer Council NSW

Surgery. Wedge resection only part of the lung, not. not a lobe, is removed. Cancer Council NSW The treatment you receive will depend on your lung cancer type, for example, whether you have a non-small cell lung cancer Adenocarcinoma or Squamous cell carcinoma, and if this is a sub-type with a mutation.

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

Adjuvant Therapy Non Small Cell Lung Cancer. Sunil Nagpal MD Director, Thoracic Oncology Jan 30, 2015

Adjuvant Therapy Non Small Cell Lung Cancer. Sunil Nagpal MD Director, Thoracic Oncology Jan 30, 2015 Adjuvant Therapy Non Small Cell Lung Cancer Sunil Nagpal MD Director, Thoracic Oncology Jan 30, 2015 No Disclosures Number of studies Studies Per Month 12 10 8 6 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3

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

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

Choosing a Clinical Trial for Advanced Mesothelioma

Choosing a Clinical Trial for Advanced Mesothelioma Choosing a Clinical Trial for Advanced Mesothelioma RN Taub (Onc) J Chabot (Surg) A Borczuk (Path) J Sonnet (Surg) M Kluger (Surg) R Fawwaz (Nuc. Med) E Hare (Onc) Columbia University Mesothelioma Center

More information

Update on Small Cell Lung Cancer

Update on Small Cell Lung Cancer Welcome to Master Class for Oncologists Session 3: 2:45 PM - 3:30 PM Washington, DC March 28, 2009 Small Cell Lung Cancer: Best Practices & Recent Advances Speaker: Bruce E. Johnson, MD Professor of Medicine,

More information

Treatment Guide Lung Cancer Management

Treatment Guide Lung Cancer Management 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 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

J of Evidence Based Med & Hlthcare, pissn- 2349-2562, eissn- 2349-2570/ Vol. 2/Issue 33/Aug. 17, 2015 Page 5063

J of Evidence Based Med & Hlthcare, pissn- 2349-2562, eissn- 2349-2570/ Vol. 2/Issue 33/Aug. 17, 2015 Page 5063 PERITONEAL MALIGNANT MESOTHELIOMA: A RARE S. R. Dhamotharan 1, S. Shanthi Nirmala 2, F. Celine Foustina Mary 3, M. Arul Raj Kumar 4, R. Vinothprabhu 5 HOW TO CITE THIS ARTICLE: S. R. Dhamotharan, S. Shanthi

More information

Controversies in Management of. Inoperable NSCLC. Inoperable NSCLC. Introduction:

Controversies in Management of. Inoperable NSCLC. Inoperable NSCLC. Introduction: Inoperable NSCLC Controversies in Management of Inoperable NSCLC Introduction: It is difficult to overemphasize the magnitude of lung cancer as Public Health Problem in our society. - In US, Lung cancer

More information

Lung Cancer. Public Outcomes Report. Submitted by Omar A. Majid, MD

Lung Cancer. Public Outcomes Report. Submitted by Omar A. Majid, MD Public Outcomes Report Lung Cancer Submitted by Omar A. Majid, MD Lung cancer is the most common cancer-related cause of death among men and women. It has been estimated that there will be 226,1 new cases

More information

ADJUVANT TREATMENT CLINICAL EVALUATION NEOADJUVANT TREATMENT

ADJUVANT TREATMENT CLINICAL EVALUATION NEOADJUVANT TREATMENT te: Consider Clinical Trials as treatment options for eligible patients. Referral to a center with both pediatric oncology and orthopedic surgery is essential. CLINICAL EVALUATION This practice algorithm

More information

What is Mesothelioma?

What 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 information

Metastatic Renal Cell Carcinoma: Staging and Prognosis of Three Separate Cases.

Metastatic 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 information

Surgeons 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 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 information

General Information About Non-Small Cell Lung Cancer

General 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 information

Maintenance therapy in in Metastatic NSCLC. Dr Amit Joshi Associate Professor Dept. Of Medical Oncology Tata Memorial Centre Mumbai

Maintenance therapy in in Metastatic NSCLC. Dr Amit Joshi Associate Professor Dept. Of Medical Oncology Tata Memorial Centre Mumbai Maintenance therapy in in Metastatic NSCLC Dr Amit Joshi Associate Professor Dept. Of Medical Oncology Tata Memorial Centre Mumbai Definition of Maintenance therapy The U.S. National Cancer Institute s

More information

Role of taxanes in the treatment of advanced NHL patients: A randomized study of 87 cases

Role of taxanes in the treatment of advanced NHL patients: A randomized study of 87 cases Role of taxanes in the treatment of advanced NHL patients: A randomized study of 87 cases R. Shraddha, P.N. Pandit Radium Institute, Patna Medical College and Hospital, Patna, India Abstract NHL is a highly

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

CHAPTER 2. Neoplasms (C00-D49) March 2014. 2014 MVP Health Care, Inc.

CHAPTER 2. Neoplasms (C00-D49) March 2014. 2014 MVP Health Care, Inc. Neoplasms (C00-D49) March 2014 2014 MVP Health Care, Inc. CHAPTER SPECIFIC CATEGORY CODE BLOCKS C00-C14 Malignant neoplasms of lip, oral cavity and pharynx C15-C26 Malignant neoplasms of digestive organs

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

Aggressive lymphomas. Michael Crump Princess Margaret Hospital

Aggressive lymphomas. Michael Crump Princess Margaret Hospital Aggressive lymphomas Michael Crump Princess Margaret Hospital What are the aggressive lymphomas? Diffuse large B cell Mediastinal large B cell Anaplastic large cell Burkitt lymphoma (transformed lymphoma:

More information

Cardiac Masses and Tumors

Cardiac 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 information

Lung Cancer: More than meets the eye

Lung Cancer: More than meets the eye Lung Cancer Education Program November 23, 2013 Lung Cancer: More than meets the eye Shantanu Banerji MD, FRCPC Presenter Disclosure Faculty: Shantanu Banerji Relationships with commercial interests: Grants/Research

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

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

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

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

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

Targeted Therapy What the Surgeon Needs to Know

Targeted Therapy What the Surgeon Needs to Know Targeted Therapy What the Surgeon Needs to Know AATS Focus in Thoracic Surgery 2014 David R. Jones, M.D. Professor & Chief, Thoracic Surgery Memorial Sloan Kettering Cancer Center I have no disclosures

More information

Lung Cancer Treatment Guidelines

Lung 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 information

INDIAN JOURNAL OF MEDICAL & PAEDIATRIC ONCOLOGY Vol. 28 No 1, 2007 1 4

INDIAN JOURNAL OF MEDICAL & PAEDIATRIC ONCOLOGY Vol. 28 No 1, 2007 1 4 INDIAN JOURNAL OF MEDICAL & PAEDIATRIC ONCOLOGY Vol. 28 No 1, 2007 1 4 Original Article-II Primary Versus Interval Cytoreductive Surgery in Treatment of Advanced Ovarian Cancer ABDUL RASHID LONE, MUSHTAQ

More information

Treatment of Small Cell Lung Cancer: American Society of Clinical Oncology Endorsement of the American College of Chest Physicians (ACCP) Guideline

Treatment of Small Cell Lung Cancer: American Society of Clinical Oncology Endorsement of the American College of Chest Physicians (ACCP) Guideline Treatment of Small Cell Lung Cancer: American Society of Clinical Oncology Endorsement of the American College of Chest Physicians (ACCP) Guideline An ASCO Endorsement of Treatment of Small Cell Lung Cancer:

More information