Extrapleural Pneumonectomy in the Multimodality Therapy of Malignant Pleural Mesothelioma

Sugarbaker, David J.; García, José Pérez; Richards, William G.; Harpole, David H.; Healy-Baldini, Elizabeth; DeCamp, Malcolm M.; Mentzer, Steven J.; Liptay, Michael J.; Strauss, Gary M.; Swanson, Scott J.

doi:10.1097/00000658-199609000-00005

Cited by 220 publications

(129 citation statements)

References 28 publications

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“…However, it should be noted that metastasis is more frequent after surgery, more often after pleuropneumonectomy than after pleurectomy [71,72]. According to the authors this could reflect the disease stage and prevalence of nodal stages.…”

Section: Evolutionmentioning

confidence: 98%

Malignant pleural mesothelioma

Boutin¹,

Schlesser²,

Frenay³

et al. 1998

Eur Respir J

171

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The incidence of malignant pleural mesothelioma (MPM) has risen for some decades and is expected to peak between 2010 and 2020. Up to now, no single treatment has been proven to be effective and death usually occurs within about 12-17 months after diagnosis. Perhaps because of this poor prognosis, early screening has incited little interest. However, certain forms may have a better prognosis when diagnosed early and treated by multimodal therapy or intrapleural immunotherapy. Diagnosis depends foremost on histological analysis of samples obtained by thoracoscopy. This procedure allows the best staging of the pleural cavity with an attempt to detect visceral pleural involvement, which is one of the most important prognostic factors. Although radiotherapy seems necessary and is efficient in preventing the malignant seeding after diagnostic procedures in patients, there has been no randomized phase III study showing the superiority of any treatment compared with another. However, for the early-stage disease (stage I) a logical therapeutic approach seems to be neoadjuvant intrapleural treatment using cytokines. For more advanced disease (stages II and III) resectability should be discussed with the thoracic surgeons and a multimodal treatment combining surgery, radiotherapy and chemotherapy should be proposed for a randomized controlled study. Palliative treatment is indicated for stage IV. In any case, each patient should be enrolled in a clinical trial.

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Section: Evolutionmentioning

confidence: 98%

Malignant pleural mesothelioma

Boutin¹,

Schlesser²,

Frenay³

et al. 1998

Eur Respir J

171

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“…2,3 Recent studies have focused on combining surgery for local control of MM (extrapulmonary pneumonectomy or decortication ) with adjuvant chemotherapy and/or radiotherapy to control distal disease with minimal success. 3,4 More recent treatment strategies for solid tumors such as MM, particularly gene therapy and immunotherapy, have shown some promise in both human 5,6 and murine studies. Several cytokines, including IL -2, 7,8 GM -CSF, 9 B7 -1, 10,11 IL -12, 12 IFN -, 13,14 and IFN - 15 have demonstrated significant antitumor effects.…”

mentioning

confidence: 99%

The immune anti-tumor effects of GM-CSF and B7-1 gene transfection are enhanced by surgical debulking of tumor

et al. 2001

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Malignant mesothelioma ( MM ) is a solid tumor largely unresponsive to conventional therapies. Immunological gene therapy shows promise in murine models and human clinical trials; however, the role of surgery in combination with gene therapy has not been widely studied. The aim of this study was to determine if debulking surgery improved the effectiveness of gene therapy in a murine MM model. Mice were subcutaneously inoculated with the MM cell line, AC29, at two different sites, 4 days apart, to allow a surgical and distal site tumor to develop. Once tumors were established, the surgical site tumor was debulked and vaccination of syngeneic tumor transfectants encoding genes for IL -4, IL -2, GM -CSF, B7 -1 or allogeneic MHC molecules commenced at a site away from both tumors, and tumor growth was measured. Neither debulking surgery nor gene therapy alone delayed tumor growth. However, there was a clear delay of tumor growth when debulking surgery was combined with vaccination of tumor transfectants expressing B7 -1 or high levels of GM -CSF. Combinations of these two transfectants did not lead to a synergistic effect. This study demonstrates that debulking surgery can augment the immunostimulatory effects of immunological gene therapy and can delay tumor growth. This has implications for the future design of human gene therapy trials for solid tumors such as MM.

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“…[3,4] With the recent introduction of trimodality treatment, involving induction chemotherapy, definitive surgery and adjuvant radiation, patients have survived as long as 5 years, but median survival does not exceed 11 months. [5,6] The use of contemporary radiation techniques as sole treatment for MPM is poorly documented. We therefore present here a case of locally advanced malignant mesothelioma, treated with a unique, customized irradiation technique.…”

Section: Introductionmentioning

confidence: 99%

Contemporary radiation therapy techniques in malignant pleural mesothelioma: a case report

Halpern¹,

McVorran

Loksen

2015

JST

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Malignant pleural mesothelioma (MPM) is a rare but very aggressive neoplasm. Prognosis is poor and the disease is fatal within 4-8 months without treatment. Even with a trimodality treatment approach, which has been shown to produce significant morbidity, median survival does not exceed 11 months. There is a need therefore for exploring new treatment options that can improve both qualitative and quantitative outcomes.This case report describes locally advanced malignant pleural mesothelioma treated with a unique, customized irradiation technique involving a combination of 3D conformal therapy and intensity modulated radiotherapy (IMRT). This allowed for treatment of the pleura to a high dose, while sparing the lung parenchyma. In this patient, our approach resulted in a prolonged remission. It is our hope that this stimulates new interest in the use of modern day radiation techniques in the treatment of MPM.

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Extrapleural Pneumonectomy in the Multimodality Therapy of Malignant Pleural Mesothelioma

Abstract: Extrapleural pneumonectomy with adjuvant therapy is appropriate treatment for selected patients with malignant mesothelioma selected using a revised staging system.

Cited by 220 publications

References 28 publications

Malignant pleural mesothelioma

Malignant pleural mesothelioma

The immune anti-tumor effects of GM-CSF and B7-1 gene transfection are enhanced by surgical debulking of tumor

Contemporary radiation therapy techniques in malignant pleural mesothelioma: a case report

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