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Published on: December 21, 2019
Multimodality approach in management of malignant pleural mesothelioma
1Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Chicago, Stritch School of Medicine, Maywood, IL, USA. sneragi@yahoo.com
Abstract:
Malignant pleural mesothelioma (MPM) is a solid, locally aggressive tumor, which has been closely linked to asbestos exposure. The survival rate without treatment ranges from 4 to 12 months. Response to chemotherapy and radiation is poor, and surgery is the most effective therapy. There are currently 3000 new MPM cases per year in the United States, with the peak incidence in the United States and Europe expected to occur in the year 2020. The prognosis depends on the stage of the tumor at the time of diagnosis, its histological type, lymph node status, and resection margins. While the diagnosis is often delayed, earlier intervention may improve life expectancy. Single-modality therapy has not been effective in changing the natural history of MPM. As a result, multimodality regimens involving surgery with radiation, chemotherapy, or immunotherapy have been initiated. Multiple modality approach has demonstrated favorable outcome, particularly in patients with epithelial histology, negative resection margins and presence of no metastases to extrapleural lymph nodes. Cisplatin and mitomycin have demonstrated modest efficacy in management of distant tumor recurrence. Cisplatin and gemcitabine regimen as well as cisplatin/pemetrexed followed by 54 Gy of adjuvant hemithorax radiation have been reported to improve the outcome.
Insights
Malignant pleural mesothelioma (MPM), a cancer linked to asbestos, has poor survival rates. Multimodality therapy, combining surgery with other treatments, shows improved outcomes for patients with specific tumor characteristics.
Area of Science:
- Oncology
- Thoracic Surgery
- Medical Oncology
Background:
- Malignant pleural mesothelioma (MPM) is an aggressive thoracic cancer strongly associated with asbestos exposure.
- Current treatments like chemotherapy and radiation show limited efficacy, with surgery being the most effective single modality.
- The United States sees approximately 3000 new MPM cases annually, with peak incidence anticipated around 2020.
Purpose of the Study:
- To review the current understanding of malignant pleural mesothelioma diagnosis and treatment.
- To evaluate the effectiveness of multimodality treatment approaches for MPM.
- To identify prognostic factors influencing patient survival and outcomes.
Main Methods:
- Review of existing literature on MPM treatment strategies.
- Analysis of outcomes associated with single-modality versus multimodality therapies.
- Examination of the role of surgery, radiation, chemotherapy, and immunotherapy.
Main Results:
- Multimodality regimens, particularly those including surgery, radiation, and chemotherapy, demonstrate improved outcomes.
- Favorable prognoses are observed in patients with epithelial histology, negative resection margins, and no extrapleural lymph node metastasis.
- Specific chemotherapy regimens like cisplatin/gemcitabine and cisplatin/pemetrexed show modest efficacy, especially with adjuvant radiation.
Conclusions:
- Multimodality therapy offers a more effective approach to managing malignant pleural mesothelioma compared to single-modality treatments.
- Prognosis is significantly influenced by tumor stage, histology, lymph node involvement, and resection margins.
- Earlier diagnosis and intervention, coupled with tailored multimodality treatment, are crucial for improving patient life expectancy.
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