Mesothelioma Prognosis Stage
Mesothelioma - a rare malignancy that develops in the mesothelium of the pleura or peritoneum. Mesothelioma can be a source of the pleura, peritoneum, pericardium, and Tunica vaginalis testis. Currently conducted additional research on elucidating the role of SV40 in mesothelioma occurs. Other etiological factors contributing to the development of mesothelioma include exposure to ionizing radiation in history and rare familial forms.
Can mesothelioma be cured
The most frequent clinical manifestations of pleural mesothelioma - shortness of breath on exertion, and dyspnea. Most physicians in identifying this symptomatology administered chest radiograph, in this case, detected sided pleural effusion. In rare cases, the tumor is at random finding routine chest radiograph. Patients also may complain of chest pain that is not related to breathing. This symptom has significant diagnostic value because it allows you to identify patients with inoperable tumors (in these cases, the pain caused by tumor invasion into the chest). Also can be observed: the asymmetry of the respiratory movements, weight loss, night sweats, and the presence of subcutaneous surround formation.
What is the complexity of the diagnosis?
When first discovered pleural effusion performed thoracentesis, to establish the nature of the effusion. Often, the patient has a negative cytology result, in such cases, for the diagnosis of mesothelioma is often to repeat a puncture. Because of the frequent negative cytology results can not be considered a reliable method for the diagnosis of mesothelioma. Furthermore, cytology is often not possible to establish histological embodiment mesothelioma, which has importance for assessing prognosis.
The best method of diagnosis of mesothelioma thoracoscopic biopsy. This method has a number of advantages. Firstly, it allows the surgeon to assess the depth of tumor invasion of the visceral and parietal pleura. Secondly, a biopsy is performed under direct vision, which is essential for the correct histological diagnosis. Finally, when thoracoscopy pleurodesis can be performed to help prevent re-effusion. It should be noted that mesothelioma lesions may occur at the site of biopsy performed earlier.
For a survey of patients with newly diagnosed mesothelioma used computed tomography (CT), positron emission tomography (PET) and magnetic resonance imaging (MRI). CT with contrast often reveals circular lobed pleural mooring line in combination with effusion in the pleural cavity or without it. Using CT pleural plaques can be detected, indicating the previous contact with asbestos, as well as tumor spread interlobar pleura. However, CT is not always possible to accurately determine whether the tumor grows into the chest wall or diaphragm. Evaluation of these parameters is very important, especially if you plan to surgical treatment of mesothelioma.
In such situations, it is advisable to use an MRI, which allows evaluating the germination in the chest wall and into the diaphragm. Since most mesothelioma PET positive, lately for the diagnosis of these tumors are more widely used PET with fluorodeoxyglucose. As well as in lung cancer, this research method allows identifying micrometastases in patients in whom surgery is planned. Nevertheless, further research is needed to determine the diagnostic value of PET with fluorodeoxyglucose for localized and locally advanced mesothelioma.
Mesothelioma survival rate stage
The literature describes many classifications for staging pleural mesothelioma, while not designed for such labeling of peritoneal mesothelioma. The main purpose of the determination step pleural mesothelioma - prediction determination, and identification of patients who may surgical treatment. The most widely used classification of the International Group for the Study of mesothelioma (the International Mesothelioma Interest Group - IMIG), is a modification of the TNM classification. To ascertain the stage of mesothelioma, based on the results of X-ray diagnostics, difficult, often this can be done only during the operation.
Prognostic factors of mesothelioma
To date, there is no radical methods of treatment of mesothelioma. The median survival of patients with newly diagnosed disease ranges from 6 to 18 months. Mesothelioma (even in the absence of treatment) may proceed differently, therefore developed several prediction evaluation systems to isolate subgroups of patients with different prognosis. The most commonly used prediction evaluation system developed by the Study Group for the Study of cancer and leukemia, as well as the European Organization for Research and Treatment of malignant tumors. The group with a poor prognosis include patients with mesothelioma sarcomatoid type, with the severe general condition, as well as patients with chest pain (indicating sprouting tumor in chest wall). Furthermore, the presence worsens the prognosis of the systemic inflammatory reaction syndrome at mesothelioma, which is manifested by leukocytosis and thrombocytosis.
To date, there are no uniform standards for the treatment of mesothelioma. One of the reasons - lack of randomized clinical trials that compare different treatments. A variety of approaches to the treatment of mesothelioma - from palliative care and chemotherapy prior to major surgery, the choice of one or the other approach depends on patient age, comorbidities, and general condition.
The actual performance of individual treatment of mesothelioma is not defined. This is due to reasons such as the rarity of the disease, the insufficient number of randomized studies, no single approach to the determination step, the differences between the histological variants mesothelioma nonequivalence of prognostic factors, and difficulty in assessing the effectiveness of treatment with CT and other diagnostic radiation methods. At the moment, it is unclear whether the increase of some method of treatment the survival rate of patients with mesothelioma compared to using only palliative therapy. The disease occurs in different ways, so the benefits identified in clinical trials may be due to the selection of patients. Many patients need to control the volume of pleural effusion and no need to immediately apply the systemic or topical treatment. Currently, a number of ongoing clinical trials investigated the efficacy of treatment in comparison with palliative therapy.
Mesothelioma survival stories: Surgery
For some patients with mesothelioma best option is surgery. One argument for this treatment lies in the fact that for mesothelioma typical local spread process on adjacent structures such as the mediastinum and chest wall, to distant metastases. Thus, surgery can have the therapeutic and palliative effect. There are two basic types of operations: plevropnevmonektomii (PES) and pleurectomy/decortication (P / D). PES is a single bloc resection of the parietal pleura, lung, pericardium and diaphragm. Then, the plastic diaphragm and the pericardium using Teflon patches. P / D, on the other hand, involves resection of the parietal and mediastinal pleura and mesothelioma affected areas of the diaphragm and the pericardium, the light remains in place. Since it is usually surgical margins do not contain healthy tissue, to date, it is not clear whether the both operations principles of oncological surgery.
Opinions regarding the surgical treatment of mesothelioma diverge. In particular, it is unclear whether the surgical treatment leads to an increased survival and improve the quality of life of patients. The study of this issue are devoted to two clinical trials conducted in the UK. The first of them - a radical surgical treatment (MARS) mesothelioma. This study involved patients with operable forms of mesothelioma; they first receiving chemotherapy, and then randomly assigned to those who continue to hold the PES and those who held other treatment. The main criterion for evaluation in this trial - overall survival, and takes into account the impact of the PES not only on overall survival but also the quality of life of patients. The second test is called MesoVATS, it newly diagnosed patients with mesothelioma and presence of pleural effusion randomly divided into groups, one of which is carried talc pleurodesis, and in the other - thoracoscopic (VATS) pleurectomy. The evaluation criteria in this test include a one-year survival rate, decrease exudate and quality of life of patients in the two groups. Both tests will help determine what contribution the operation in the treatment of patients with mesothelioma.
Despite the surgery, most patients relapse mesothelioma. To some extent, the recurrence rate is determined by the type of operation. Patients undergoing PES can develop local recurrences at the side of the operation, although it is more characterized by the appearance of distant metastases. After P / D, on the contrary, there is a tendency to local recurrence. To reduce the incidence
of local recurrence and distant metastases, using photodynamic therapy, intracavitary chemotherapy and adjuvant and neoadjuvant systemic chemotherapy.
Mesothelioma survival stories: Chemotherapy
Cchitaetsya that mesothelioma is resistant to systemic chemotherapy in clinical trials for the treatment of mesothelioma tried to use the majority of drugs. The most effective monotherapy showed antifolates, platinum derivatives (cisplatin and carboplatin), vinorelbine and gemcitabine. The drug is administered intravenously, not only, but also in the pleural or peritoneal cavity. In phase III clinical trials comparing the efficacy of cisplatin plus pemetrexed, cisplatin monotherapy as the initial treatment of patients with mesothelioma. It has been shown that the remission rates (41%) and median survival (12 mo.) Higher in the group of patients treated with combination chemotherapy as compared to those who received mono-chemotherapy (16.7 and 9.3% respectively). Based on the results of this study the combination of cisplatin and pemetrexed was formally approved by FDA for the treatment of mesothelioma and included in the standard treatment of this disease.
Also studied and demonstrated the efficacy of alternative chemotherapeutic agents, particularly folate antimetabolites (gemcitabine, cisplatin / gemcitabine), and platinum derivatives (carboplatin; carboplatin / pemetrexed). To date, ongoing studies on the effectiveness of second-line chemotherapy for mesothelioma.
In addition to chemotherapy, we investigated the use of targeted therapies with mesothelioma. According to preliminary results or inhibitors of the epidermal growth factor receptor (gefitinib and erlotinib), inhibitors or platelet-derived growth factor receptor (imatinib) have no activity against mesothelioma. As tumor angiogenesis is characterized by high activity, high-efficiency monotherapy showed angiogenesis inhibitors such as SU5416, thalidomide, and PTK787. Finally, to date completed phase II clinical trial large randomized dedicated to studying the efficacy of bevacizumab ( monoclonal antibody to vascular endothelial growth factor); the results of this study have not been published.
Mesothelioma survival stories: Radiation therapy
Most patients with mesothelioma chemotherapy are ineffective. Radiation therapy is often used for palliation, and also to reduce the risk of germination tumor zone where performed surgery or biopsy was performed. Moreover, irradiation of the affected part of the chest is used after the PES. Since in many cases, after the PES at the resection margin (or very close to it) detecting tumor cells, radiation therapy reduces the incidence of local recurrence. In patients with early stages of mesothelioma who underwent irradiation of the affected part of the chest, lower the risk of relapse in the operation zone, but the much higher risk of getting distant metastases. In the treatment of the majority of these patients used a combination of surgery, chemotherapy, and radiotherapy.