Neoadjuvant Chemotherapy Followed by Extrapleural Pneumonectomy in Malignant Pleural Mesothelioma

Weder, Walter; Kestenholz, Peter; Taverna, Christian; Bodis, Stephan; Lardinois, Didier; Jerman, Monika; Stahel, Rolf A.

doi:10.1200/jco.2004.10.071

Cited by 236 publications

(146 citation statements)

References 32 publications

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“…18 F-FDG PET/CT would thus be more informative for diagnosis of pleural diseases than examination with 18 F-FDG PET (7). The incidence of malignant pleural mesothelioma (MPM) in many countries including Japan is rising, as predicted (8,9), (10,11). Only a small number of patients with MPM are deemed suitable candidates for multimodality therapy which includes chemotherapy, surgery and radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Clinical implications of 18F-fluorodeoxyglucose positron emission tomography/computed tomography at delayed phase for diagnosis and prognosis of malignant pleural mesothelioma

Abe¹

2011

Oncol Rep

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Abstract. Malignant pleural mesothelioma (MPM) has a poor prognosis, and conventional imaging modalities do not reflect the prognosis of MPM. In this study, the clinical significance of 18 F-fluorodeoxyglucose positron emission tomography/ computed tomography fusion imaging ( 18 F-FDG PET/CT) was evaluated for the differential diagnosis, staging and prognosis in MPM patients. Ninety patients who underwent 18 F-FDG PET/CT scanning due to a clinical diagnosis or suspicion of MPM prior to therapy were reviewed. Of 90 patients, 31 were pathologically diagnosed as MPM. Maximum standardized uptake values (SUVmax) were semi-quantitatively obtained from PET/CT 60 min (early phase) and 120 min (delayed phase) after injection of 18 F-FDG, and the clinicopathological correlations with the level of SUVmax obtained from PET/CT were examined. The survival curves of MPM patients were plotted according to the methods of Kaplan-Meier. The prognostic implications of the level of SUVmax were estimated by t-test. PET/CT scan showed intense abnormal FDG uptake (SUVmax >2.0) in the pleural lesions of all 31 MPM patients at delayed phase, while it showed abnormal FDG uptake in 30 (97%) patients at early phase. In all 31 MPM patients, the values of SUVmax at delayed phase were higher than those at the early phase. PET/CT also indicated metastasis in the lymph node in 7 patients (23%) and in the systemic lesions in 8 patients (26%) with MPM. Twenty-three MPM patients with high SUVmax, whose prognosis was apparent, showed significantly poorer prognosis in both early and delayed phase (respectively, p=0.03 and p=0.01, t-test). The results showed that 18 F-FDG PET/CT at delayed phase is very useful for the diagnosis of pleural diseases, and SUVmax on PET/CT in the delayed phase is a more reliable prognostic factor than that in the early phase. High uptake of 18 F-FDG PET/CT may be a predictive factor of prognosis in MPM patients. IntroductionThe most common cause of pleural effusion is nonspecific pneumonia which can be successfully treated with proper antibiotic therapy. However, pleural effusion may persist and require further examinations in some cases in spite of proper therapy. Computed tomography (CT) provides detailed information on morphological changes, but on its own cannot differ entiate between benign and malignant diseases. Also, invasive pro cedures are frequently required for a definitive diagnosis (1). Many studies have reported the value of 18 F-FDG PET/CT would thus be more informative for diagnosis of pleural diseases than examination with 18 F-FDG PET (7). The incidence of malignant pleural mesothelioma (MPM) in many countries including Japan is rising, as predicted (8,9),

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Section: Introductionmentioning

confidence: 99%

Clinical implications of 18F-fluorodeoxyglucose positron emission tomography/computed tomography at delayed phase for diagnosis and prognosis of malignant pleural mesothelioma

Abe¹

2011

Oncol Rep

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“…This is valid for the classic trimodality approach pioneered by Sugarbaker and colleagues [15], for the neoadjuvant chemotherapy strategy proposed by Weder and associates [5], and for the intensitymodulated adjuvant radiotherapy established by Rice and coworkers [16]. Nonetheless, results achieved are not yet satisfying, and median survival is quite low.…”

Section: Commentmentioning

confidence: 74%

“…Despite extensive surgical removal provided by extrapleural pneumonectomy, patients relapsed rapidly. Therefore, most treatment regimens have focused on radiation therapy, chemotherapy and immunotherapy multimodality treatment [4], or neoadjuvant chemotherapy [5].…”

mentioning

confidence: 99%

“…These tumoral nests are likely located in proximity of resection margins or in mediastinal nodes not adequately assessed at the time of thoracotomy. Indeed, positive resection margins and mediastinal lymph node metastases have been identified as poor prognostic factors in many published series [3][4][5][6][7][8][9][10][11][12]. However, some patients experience a poor outcome despite a histologically proven complete surgical resection.…”

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confidence: 99%

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The Value of Occult Disease in Resection Margin and Lymph Node After Extrapleural Pneumonectomy for Malignant Mesothelioma

Mineo

Ambrogi

Pompeo

et al. 2008

The Annals of Thoracic Surgery

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“…In contrast, McCormack et al [43] reported an operative mortality of 1.8% for P/D. The response rate of the cisplatin-GEM doublet has been reported to range between 16 and 47%, and was 32% in a neo-adjuvant trial [44]. The response to the pemetrexed-cisplatin doublet has been reported to be 41% in advanced MPM, so most groups are now exploring this combination in a neo-adjuvant setting.…”

Section: Radiotherapy For Malignant Pleural Mesotheliomamentioning

confidence: 99%

Current therapies for malignant pleural mesothelioma

Nakano

2008

Environ Health Prev Med

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Mesothelioma is a highly lethal tumor derived from mesothelial cells, and its global incidence is increasing because of widespread exposure of numerous individuals to asbestos in the last 50 years. Mesothelioma is largely untreatable with any of the therapeutic modalities. Recently, a novel multitargeted antifolate pemetrexed has shown promising activity against malignant pleural mesothelioma, producing response rates of up to 40% when used in combination with cisplatin. In a large phase III study, use of a combination of pemetrexed and cisplatin was associated with significantly improved survival time and with greater antitumor activity compared with cisplatin alone. This combination also gave a significant response rate of approximately 50% in patients with epithelioid malignant pleural mesothelioma. These clinical benefits of pemetrexed-cisplatin doublet have changed the perception of mesothelioma chemotherapy. Other combinations, including gemcitabine in combination with cisplatin, have also shown encouraging response rates. Prognosis depends on gender, clinical stage of the tumor, histological subtype, platelet count, leukocyte counts, and performance status. Radiotherapy can palliate mesothelioma patients with chest pain, and has been indicated to be of benefit for the prevention of malignant seeding along the tract of a chest tube or needle biopsy. Trimodality treatment using extrapleural pneumonectomy, radiation and chemotherapy has shown promising therapeutic value. The development of chemotherapeutic regimens and the favorable outcomes of trimodality have led to new combined modality trials. In Japan, multicenter national trials against mesothelioma will begin in the near future.

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Neoadjuvant Chemotherapy Followed by Extrapleural Pneumonectomy in Malignant Pleural Mesothelioma

Cited by 236 publications

References 32 publications

Clinical implications of 18F-fluorodeoxyglucose positron emission tomography/computed tomography at delayed phase for diagnosis and prognosis of malignant pleural mesothelioma

Clinical implications of 18F-fluorodeoxyglucose positron emission tomography/computed tomography at delayed phase for diagnosis and prognosis of malignant pleural mesothelioma

The Value of Occult Disease in Resection Margin and Lymph Node After Extrapleural Pneumonectomy for Malignant Mesothelioma

Current therapies for malignant pleural mesothelioma

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