Clinical staging of malignant pleural mesothelioma: current perspectives

Abstract

Malignant pleural mesothelioma (MPM) is a disease with limited therapeutic options, the management of which is still controversial. Diagnosis is usually made by thoracoscopy, which allows multiple biopsies with histological subtyping and is indicated for staging purposes in surgical candidates. The recommended and recently updated classification for clinical use is the TNM staging system established by the International Mesothelioma Interest Group and the International Association for the Study of Lung Cancer, which is based mainly on surgical and pathological variables, as well as on cross-sectional imaging. Contrast-enhanced computed tomography is the primary imaging procedure. Currently, the most used measurement system for MPM is the modified Response Evaluation Criteria in Solid Tumors (RECIST) method, which is based on unidimensional measurements of tumor thickness perpendicular to the chest wall or mediastinum. Magnetic resonance imaging and functional imaging with 18F-fluoro-2-deoxy-D-glucose positron-emission tomography can provide additional staging information in selected cases, although the usefulness of this method is limited in patients undergoing pleurodesis. Molecular reclassification of MPM and gene expression or miRNA prognostic models have the potential to improve prognostication and patient selection for a proper treatment algorithm; however, they await prospective validation to be introduced in clinical practice.

Complex Target Volume Delineation and Treatment Planning in Radiotherapy for Malignant Pleural Mesothelioma (MPM)

“…(3) Surgery: Radiotherapy after extrapleural pleuropneumonectomy [15]. (4) Pilot study: Different types of surgery and chemotherapy for different patients [16]. (5) Trimodality treatment = surgery included [17].…”

“…But, non-asbestos-related mesothelioma has been reported [3]. The typical growth pattern is along the pleural surface; but, infiltration of the lung and/or mediastinal and chest wall structures can occur in a more advanced stage while distant metastases outside the chest can result also [4]. Video thoracoscopy is the standard procedure for confirming the disease and obtaining sufficient tissue for the diagnosis; and the complete and detailed staging is mandatory for MPM categorization and for therapeutic decision making [5].…”

A case from India of pleural malignant mesothelioma probably due to domestic and environmental asbestos exposure: a posthumous report

“…Nine of the 13 lymph nodes resected showed evidence of tumour with extranodal extension. The tumour-node-metastasis staging at that time was T3, N1, M0, stage III 4–6. Four months later, a follow-up FDG-PET/CT showed evidence of the disease in the abdomen and bone.…”

Staging in the era of international databases: documented improvements with remaining challenges

“…All of the staging projects have been dominated by surgical data which are available only following surgical resection and cannot be universally applied prior to initiation of therapy. Functional imaging (e.g., PET), magnetic resonance imaging, as well as volumetric and other novel imaging measurements need to be actively evaluated and incorporated in the process to improve clinical staging and decrease the differences between clinical and pathological staging (18,19). Thirdly, biases have not been eliminated.…”