Preoperative prediction of unresectability in malignant pleural mesothelioma

Preoperative Identification of Benefit from Surgery for Malignant Pleural Mesothelioma

“…57 These techniques are reflective of the underlying tumor pathophysiology, such as tissue cellularity and microvessel density. 57 In the analysis of preoperative prediction of unresectability in MPM, Burt and colleagues 76 proposed a novel metric of thoracic cage volume, calculated by preoperative chest CT scan, and determined associations between preoperative variables and diffuse chest wall invasion (DCWI) and contraction of thoracic cage volume in patients scheduled for MCR. Decreased ipsilateral thoracic cage volume demonstrated the strongest association with unresectability by DCWI (P 5 .009), with greater than 5% decrease representing the optimal cutoff (P 5 .014; area under the curve, 0.67).…”

Commentary: Is thoracic cage volume a new parameter for clinical staging in mesothelioma?

“…1 MCR is currently achieved in approximately 70% of patients undergoing surgery for mesothelioma. 2 Hence, studies to define preoperative indicators that could help reduce the rate of incomplete resection are important.…”

“…The authors observed that diffuse chest wall invasion is more frequent in patients with ipsilateral chest wall retraction. 2 They, therefore, developed a novel metric based on 3-dimensional thoracic cage volume (TCV) using computed tomography scanning and analyzed the degree Ipsilateral thoracic cage volume reduction is associated with a greater risk of diffuse chest wall invasion and could help refine the clinical staging in malignant pleural mesothelioma.…”

Commentary: Surgeon versus mesothelioma in a thoracic cage match

“…Burt and colleagues 3 have developed an elegant method to specifically assess tumor involvement vis-a-vis DCWI along the bony chest wall. This added information is only A relative decreased volume of the hemithorax as calculated from CT image data is associated with extensive chest wall invasion by mesothelioma and suggests unresectability.…”

“…Multimodal treatment strategies have flourished as the thoracic oncology community grapples with these problems. 1,2 For selected patients with early stage disease and favorable histologic type, surgery can be part of a curative approach 3 ; however, surgery can also be a painful and ultimately fruitless undertaking in many patients. 4 Futile surgery is harmful in many ways; it can reduce quality of life and delay or disqualify patients from receiving other, more appropriate therapies.…”