Another interesting study is called, “Pleural Mesothelioma” by N Martini, PM McCormack, MS Bains, LR Kaiser, ME Burt and BS Hilaris – The Annals of Thoracic Surgery, Vol 43, 113-120. Here is an excerpt: “Pleural mesotheliomas are uncommon tumors. Correct diagnosis of the benign variant is rarely made preoperatively, and resection is the treatment of choice and is curative. Malignant pleural mesotheliomas are locally aggressive and difficult to treat. They may be seen clinically as localized pleural tumors or as diffuse pleural disease with effusion and encasement of the lung and obliteration of the pleural space. The localized forms of malignant mesotheliomas are fibrosarcomatous. Their diagnosis and treatment do not differ from those for soft-part sarcomas seen elsewhere. Wide en-bloc excision is the treatment of choice and can be curative. The diffuse forms of malignant mesotheliomas are mainly epithelial. Treatment is generally unsatisfactory, and long-term survival is rare. Two surgical approaches are currently available: an extrapleural pneumonectomy and a pleurectomy with irradiation. The authors favor the latter approach because of its wider applicability, lower morbidity rate, and better survival advantage. Steps in selecting the best surgical mode of treatment are presented.”
Another interesting study is called, Second-line (post-study) chemotherapy received by patients treated in the phase III trial of pemetrexed plus cisplatin versus cisplatin alone in malignant pleural Mesothelioma” – Ann Oncol (June 2005) 16 (6): 923-927 by C. Manegold, J. Symanowski, U. Gatzemeier, M. Reck, J. von Pawel, C. Kortsik, K. Nackaerts, P. Lianes and N. J. Vogelzang – Here is an excerpt: “Abstract – Background: A phase III trial in patients with malignant pleural mesothelioma demonstrated a survival advantage for pemetrexed plus cisplatin compared with single-agent cisplatin. Because post-study chemotherapy (PSC) may have influenced the outcome of the trial, we examined its use and association with survival. Patients and methods:: Eighty-four patients from the pemetrexed plus cisplatin arm and 105 patients from the single-agent cisplatin arm received PSC. Kaplan–Meier survival estimates were compared by treatment groups, and by PSC and non-PSC subgroups. Results: The percentage of patients receiving PSC was imbalanced between the treatment arms. Fewer pemetrexed plus cisplatin treated patients received PSC (37.2% versus 47.3%). A multiple regression analysis performed in this trial showed that PSC had a statistically significant correlation with prolonged survival (P?<0.01), adjusting for baseline prognostic factors and treatment intervention. The adjusted hazard ratio for PSC over non-PSC subgroups was 0.56 (confidence interval 0.44–0.72). Conclusions: PSC in malignant pleural mesothelioma was significantly associated with prolonged survival. It is not known whether the reduced risk of death was associated with PSC or whether patients who had prolonged survival tended to receive more PSC. The pemetrexed plus cisplatin treatment group had a statistically significant survival advantage even though fewer patients from that arm of the trial received PSC. The potentially beneficial role of PSC should be assessed in prospective trials.”
Another interesting study is called, “Immunocytochemistry of malignant mesothelioma: OV632 as a marker of malignant Mesothelioma” by M. Delahaye, H. C. Hoogsteden, Th. H. Van Der Kwast – The Journal of Pathology – Volume 165, Issue 2, pages 137–143, October 1991. Here is an excerpt: “Abstract – In pleural of ascitic effusions the cytomorphological distinction of adenocarcinoma cells, reactive mesothelial cells, and malignant mesothelioma cells often causes a diagnostic dilemma. The value of immunocytochemistry was investigated on cytological smears of 24 well-established cases of malignant mesothelioma, a selected series of 31 metastatic adenocarcinomas, and 20 smears of patients without known malignancy. In these smears we scored the immunoreactivity with a panel of four monoclonal antibodies. In addition to antibodies for epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA), the monoclonal antibody MOC31 and the ovarian carcinoma specific antibody OV632 were incorporated in the panel. With none of these four antibodies was immunostaining of reactive mesothelial cells found.
CEA- and MOC31-positive tumour cells were frequent in metastatic adenocarcinomas, but occurred rarelay in malignant mesothliomas. EMA-positive tumour cells were in all metastatic adenocarcinomas (100 per cent) and in most malignant mesotheliomas (83 per cent). In addition to the expected reactivity of OV632 with ovarian carcinomas, 22 of 24 malignant mesotheliomas contained immunopositive tumour cells, while only a small proportion of non-ovarian adenocarcinomas reacted with this antibody. This selective staining of malignant mesothelioma cells, but not reactive mesothelial cells, with OV632 now permits the positive identification of malignant mesothelioma cells in male patients.”
Tags: annals of thoracic surgery, correct diagnosis, extrapleural pneumonectomy, malignant pleural mesothelioma, malignant pleural mesotheliomas, morbidity rate, pleural tumors, Pleurectomy, symanowski, uncommon tumors