Mesothelioma is an Aggressive Primary Neoplasm
Mesothelioma is an Aggressive Primary Neoplasm
Another interesting study is called, "Assessment of Malignant Pleural Mesothelioma with 18F-FDG Dual-Head Gamma-Camera Coincidence Imaging: Comparison with Histopathology" by Victor H. Gerbaudo, PhD, David J. Sugarbaker, MD, Scott Britz-Cunningham, MD, PhD, Marcelo F. Di Carli, MD1, Charles Mauceri1 and S. Ted Treves, MD - Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; 2 Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts - Journal of Nuclear Medicine Vol. 43 No. 9 1144-1149. Here is an excerpt: "Malignant pleural mesothelioma is an aggressive primary neoplasm for which early detection and accurate staging are known diagnostic challenges. The role of 18F-FDG dual-head gamma-camera coincidence imaging (18F-FDG-CI) is yet to be defined. The purpose of this study was to evaluate the usefulness of 18F-FDG-CI in the assessment of malignant pleural mesothelioma using histopathology as the gold standard. Methods: Fifteen consecutive patients with CT scan evidence of pleural thickening, fluid, plaques, or calcification underwent 18F-FDG imaging 1.5 h after the intravenous administration of 370 MBq 18F-FDG. Imaging was performed with a dual-head gamma camera equipped with 2.54-cm-thick NaI crystals operating in coincidence mode. Using an iterative algorithm, whole-body images were reconstructed as transaxial, sagittal, and coronal images. No attenuation correction was applied. The results of 18F-FDG-CI scans were compared with CT and with histopathologic diagnosis. Results: Eleven of 15 patients had histologically proven malignant mesotheliomas (10 epithelial, 1 sarcomatoid). All 11 primary tumors were detected by 18F-FDG, and absence of disease was confirmed in the 4 patients who were disease free. Thirty-four lesions were biopsied; among these, 29 were found to be positive for tumor. 18F-FDG was true-positive in 28 lesions, true-negative in 4, false-negative in 1 (0.5 cm in diameter), and false-positive in 1 (inflammatory pleuritis). The smallest lesion detected was 0.8 cm. For biopsied lesions, overall sensitivity, specificity, and accuracy for 18F-FDG-CI were 97%, 80%, and 94% respectively, compared with 83%, 80%, and 82% for CT. Twenty-one of 29 positive lesions involved the pleura, lung parenchyma, or chest wall and were all 18F-FDG avid. In the mediastinum, 18F-FDG-CI detected 7 of 8 biopsy-positive lesions (88%), whereas CT was positive in 6 of 8 lesions (75%). 18F-FDG identified extrathoracic metastases in 5 patients, excluding them from surgical therapy. Conclusion: These preliminary results suggest that 18F-FDG-CI appears to be an accurate method to diagnose and to define the extent of disease in patients with diffuse malignant pleural mesothelioma."
Another interesting study is called, "Phase II study of pemetrexed in combination with carboplatin in patients with malignant pleural mesothelioma (MPM)" by B. Castagneto, M. Botta1, E. Aitini, F. Spigno, D. Degiovanni, O. Alabiso, M. Serra, A. Muzio, R. Carbone, R. Buosi, V. Galbusera, E. Piccolini, L. Giaretto, L. Rebella and M. Mencoboni - Ann Oncol (2008) 19 (2): 370-373. Here is an excerpt: "Abstract - Background: The aim of this study was to evaluate the activity and toxicity of pemetrexed and carboplatin combination as first-line chemotherapy in malignant pleural mesothelioma (MPM). Patients and methods: Patients with measurable advanced MPM and a zero to two Eastern Cooperative Oncology Group (ECOG) performance status (PS) were enrolled. The schedule was pemetrexed 500 mg/m2 in combination with carboplatin area under the curve 5, every 21 days. In all, 76 patients were treated. Median age was 65 years; median ECOG PS was zero.
Results: Grade 3 hematological toxicity according to World Health Organization criteria was seen in 36 (47.3%) patients; grade 4 hematological toxicity in 5 (6.5%) patients. There were 16 (21%) partial responses and 3 (4%) complete responses, for an overall response rate of 19 (25%) [95% confidence interval (CI) 15.334.7]. In all, 29 (39%) (95% CI 2848) patients reported stable disease. The median survival was estimated at 14 months. Conclusion: This combination of carboplatin and pemetrexed is moderately active and the toxicity is acceptable.
Another interesting study is called, "Surgical approach to pleural diffuse mesothelioma in Japan" by Keigo Takagia, Ryosuke Tsuchiyab, Yoh Watanabec - Volume 31, Issue 1, Pages 57-65 (1 January 2001). Here is an excerpt: "Abstract - The current status of the surgical treatment of patients with pleural diffuse mesothelioma in Japan was surveyed from the results of a questionnaire sent to members of The Japanese Association for Chest Surgery. Physicians at 57 institutions returned the questionnaire, and a total of 189 surgical cases of diffuse mesothelioma between 1987 and 1996 were analyzed. The age of the patients ranged between 18 and 80 years. They consisted of 154 males and 33 females (the gender of two patients was not indicated). By histological type, 104 cases had the epithelial type, 29 cases had the sarcomatous type, and 46 cases had the mixed type of diffuse mesothelioma (the histology of 10 patients was not indicated). As to the type of surgery, pleuropneumonectomy was performed in 116 cases (61%), and limited resection [including decortication (5 cases) and tumorectomy (68 cases)] was performed in 73 cases (39%). The goal of pleuropneumonectomy is radical resection of the tumor, which often requires combined resection of adjacent structures. The tumor was completely removed macroscopically in 84 (72%) of the 116 cases who underwent pleuropneumonectomy; however, among those with an epithelial-type tumor that was completely removed by pleuropneumonectomy, the tumor recurred postoperatively in 43% of these patients. Perioperative adjuvant therapy was performed in 83 of the 116 patients who underwent pleuropneumonectomy. The 2-year and 5-year survival rates of those who had undergone pleuropneumonectomy were 29.7 and 9.1%, respectively, and the perioperative mortality rate of this procedure was 6%. Limited resection, on the other hand, did not involve radical resection of the tumor. The 2-year and 5-year survival rates of the patients who had undergone limited resection were 26.1 and 9.5%, respectively, and the perioperative mortality rate was 6%. The survival rates and perioperative mortality rate of the patients who had undergone pleuropneumonectomy or limited resection did not significantly differ. The prognostic factors for survival included gender (P=0.0019) and adjuvant therapy (P=0.0034) by Cox's Regression Analysis. The goals of surgical treatment of pleural diffuse mesothelioma are relief of symptoms and prolongation of survival time. Selecting the appropriate surgical procedure and more effective adjuvant therapy for each particular case is necessary under a new, accurate staging system for diffuse mesothelioma."
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