Staging algorithm for diffuse malignant pleural mesothelioma☆

The prognosis of malignant pleural mesothelioma is dismal with mean survival without treatment ranging from 4 to 12 months with no single treatment modality proved to have any impact on the results of treatment w1, 2x

Marcin Zieliński

2009

Scholarcy highlights

  • The prognosis of malignant pleural mesothelioma is dismal with mean survival without treatment ranging from 4 to 12 months with no single treatment modality proved to have any impact on the results of treatment w1, 2x
  • Initial selection was made to choose patients who were possible candidates for multimodality treatment based on patient’s general condition, co-morbidities and clinical stage of MPM, which was established on the results of chest computed tomography, abdominal ultrasound and thoracoscopy findings
  • In the patients who were not excluded at this point, the staging algorithm consisting of initial EBUS andyor EUS to discover metastatic mediastinal nodes was applied in all but four patients who underwent transcervical extended mediastinal lymphadenectomy without EBUSyEUS
  • There were 21y42 patients who were found unfit for extrapleural pneumonectomy due to co-morbidities andyor advanced clinical stage IIIyIV
  • There were three other patients who were referred to neoadjuvant chemotherapy after positive thoracoscopic pleural biopsy and restaged afterwards; these patients were excluded from the current study
  • The other 18 patients with stage cI and cII disease without contraindications to multimodality treatment who were regarded candidates for multimodality treatment starting from EPP underwent further staging studies
  • Dr Hauer: This is what we did in our study, and looking back at computed tomography, there was no strong evidence of chest wall infiltration in all seven patients who underwent thoracotomy, and that is why we go for it, I would say, because it was all seven patients in good performance status, epithelioid type, we do not confirm N2 disease, intraabdominal disease, and there was no strong evidence of chest wall infiltration

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