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Implantation and Monitoring by PET/CT of an Orthotopic Model of Human Pleural Mesothelioma in Athymic Mice
Published on: December 21, 2019
SEOM guidelines for the treatment of malignant pleural mesothelioma
Pilar Lianes1, Jordi Remon, Isabel Bover
1Servicio de Oncología Médica, Hospital de Mataró, Mataró, Barcelona, Spain. plianes@csdm.cat
Abstract:
Mesothelioma is a rare malignant tumour. Asbestos is the principal aetiological agent of malignant pleural mesothelioma (MPM) (≈80% of cases). The incidence of MPM is still increasing and will peak within the next 10 years. There are three main histological types of MPM: epithelial (≈60%), sarcomatous and mixed. There is no standard approach for patients with MPM. Surgery (radical extra-pleural pneumonectomy or pleurectomy/decortication) may be part of the initial treatment for carefully selected patients, generally combined with neoadjuvant or adjuvant chemotherapy and/or adjuvant radiotherapy, and should only be performed by experienced thoracic surgeons as part of a multidisciplinary team. Radiotherapy could be used as prophylaxis to reduce the incidence of recurrence at sites of diagnoses or therapeutic instrument insertion, in a multimodal treatment to improve locoregional control and to palliate symptoms. Based on the better compliance of neoadjuvant chemotherapy, lower rate of surgical morbidity and the possibility to select the optimal patients to be submitted to surgery, a neoadjuvant strategy is a better option than adjuvant chemotherapy, although there is no standard optimal sequence and types of treatment for multimodal therapy. In patients with no resectable disease, chemotherapy is the best option with platinum and pemetrexed or raltitrexed. At this time there is no widely approved salvage therapy.
Insights
Malignant pleural mesothelioma (MPM), primarily caused by asbestos exposure, is a rare cancer with increasing incidence. Multimodal treatment strategies are evolving, with neoadjuvant chemotherapy showing promise.
Area of Science:
- Oncology
- Thoracic Surgery
- Medical Oncology
Background:
- Malignant pleural mesothelioma (MPM) is a rare cancer strongly linked to asbestos exposure, accounting for approximately 80% of cases.
- The incidence of MPM is rising and is projected to peak within the next decade.
- MPM presents in three main histological types: epithelial, sarcomatous, and mixed.
Framework:
- No universally accepted standard treatment approach exists for MPM.
- Multimodal therapy, including surgery (extra-pleural pneumonectomy or pleurectomy/decortication), chemotherapy, and radiotherapy, is often employed.
- Treatment decisions are complex and require a multidisciplinary team approach, with surgery reserved for carefully selected patients.
Implementation:
- Neoadjuvant chemotherapy is favored over adjuvant chemotherapy due to better patient compliance and reduced surgical morbidity.
- Radiotherapy can be utilized for prophylaxis against recurrence, to enhance locoregional control, and for symptom palliation.
- For unresectable disease, chemotherapy regimens including platinum and pemetrexed or raltitrexed are the primary treatment option.
Implications:
- The optimal sequence and combination of treatments within multimodal therapy for MPM remain under investigation.
- There is currently no widely approved salvage therapy for patients who do not respond to initial treatments.
- Further research is needed to establish standardized treatment protocols and improve outcomes for MPM patients.
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