Friday, September 15th, 2006.

Revista Portuguesa de Pneumologia. 2005 Nov;11(6 Suppl 1):16-8. [Link]

Lopes C, Sotto-Mayor R, Teixeira E, Almeida A.

Servico de Pneumologia, Hospital de Santa Maria, Lisboa.

Abstract

Introduction: Malignant mesothelioma (MM) is a rare neoplasm arising from mesothelial cells. Most common location is the pleura followed by the peritoneum.

Aim: Evaluate the clinical characteristics, therapy regimens and survival of mesothelioma patients, observed in our Department, between January 1995 and August 2005.

Population and methods: We retrospectively reviewed the clinical files of all mesothelioma patients observed in our Pulmonology Oncologic Unit between January 1995 and August 2005 . We evaluated clinical characteristics, diagnostic methods, clinical staging at diagnosis, performance status (ECOG), management and outcomes.

Results: Clinical files from 15 mesothelioma patients were reviewed, 14 were males. The median age at diagnosis was 61 years (range 47-78). Histologicaly, the epithelial type was the most frequent – 7 cases (47%). Occupational exposure to asbestos was identified in 10 patients. Nine patients had current or former smoking habits. The most common presenting symptom was chest pain (10), followed by dyspnoea (9) and cough (4). Two were asymptomatic – pulmonary nodule and pleural effusion found on routine chest x-ray. One single patient presented with vascular thrombosis. Pleural effusion (14) along with pleural plaques (9) were the most common imagiologic findings. Right pleura was mostly affected (10). In every case, the diagnosis was made by pleural biopsy; obtained through thoracoscopy (6), thoracotomy (3), thoracocentesis (3) and transthoracic needle aspiration (1). Pathologic staging at diagnosis revealed: stage IV (8), stage II (4) and stage I (3). Twelve patients had performance status (ECOG) 1 at diagnosis. Four patiens (stage I-II) underwent surgery: left pleuropneumectomy (1) and tumoral excision with parietal pleurectomy (3). Nine patients received chemotherapy alone: gemcitabine+platinum agent in eight patients, and pemetrexed+carboplatinum in another, as first line regimens. In four of these patients, a second line regimen, including pemetrexed, was administered. Palliative radiotherapy was given in 2 cases. Eight patients underwent pleurodesis because of recurrent pleural effusion, four with talc and one with nitrogen mustard. Talc pleurodesis performed by thoracoscopy achieved better results than chest drainage approach. The median survival time after diagnosis was 22 months (4-57). In patients who received combined chemotherapy and talc pleurodesis the median survival was 44 months (13-57 months).

Discussion: As demonstrated by the small series in ten years, malignant mesothelioma is a rare tumour. Relationship with asbestos exposure was proven in 67% of cases. Chemotherapy associated with talc pleurodesis increased survival and palliated symptoms.

Glossary

therapy

any of the measures taken to treat a disease. Unproven therapy is any therapy that has not been scientifically tested and approved. Use of an unproven therapy instead of standard (proven) therapy is called alternative therapy. Some alternative therapies have dangerous or even life-threatening side effects. For others, the main danger is that a patient may lose the opportunity to benefit from standard therapy. Complementary therapy, on the other hand, refers to therapies used in addition to standard therapy. Some complementary therapies may help relieve certain symptoms of cancer, relieve side effects of standard cancer therapy, or improve a patient's sense of well-being. The ACS recommends that patients considering use of any alternative or complementary therapy discuss this with their health care team.

staging

the process of finding out whether cancer has spread and if so, how far. There is more than one system for staging. The TNM system, described below, is one used often. The TNM system for staging gives three key pieces of information: T refers to the size of the Tumor N describes how far the cancer has spread to nearby Nodes M shows whether the cancer has spread (Metastasized) to other organs of the body Letters or numbers after the T, N, and M give more details about each of these factors. To make this information somewhat clearer, the TNM descriptions can be grouped together into a simpler set of stages, labeled with Roman numerals. In general, the lower the number, the less the cancer has spread. A higher number means a more serious cancer.

regimen

(rej-uh-men) a strict, regulated plan (such as diet, exercise, or other activity) designed to reach certain goals. In cancer treatment, a plan to treat cancer.

pleura

(pler-uh) the membrane around the lungs and lining of the chest cavity. (Pleural mesothelioma.)

neoplasm

(nee-o-plas-um) an abnormal growth (tumor) that starts from a single altered cell; a neoplasm may be benign or malignant. Cancer is a malignant neoplasm.

needle aspiration

a type of needle biopsy. Removal of fluid from a cyst or cells from a tumor. In this procedure, a needle is used to reach the cyst or tumor, and with suction, draw up (aspirate) samples for examination under a microscope. If the needle is thin, the procedure is called a fine needle aspiration or FNA. (See also biopsy.)

diagnosis

identifying a disease by its signs or symptoms, and by using imaging procedures and laboratory findings. The earlier a diagnosis of cancer is made, the better the chance for long-term survival.

chemotherapy

(key-mo-THER-uh-pee) treatment with drugs to destroy cancer cells. Chemotherapy is often used with surgery or radiation to treat cancer when the cancer has spread, when it has come back (recurred), or when there is a strong chance that it could recur.

biopsy

(buy-op-see) the removal of a sample of tissue to see whether cancer cells are present. There are several kinds of biopsies. In some, a very thin needle is used to draw fluid and cells from a lump. In a core biopsy, a larger needle is used to remove more tissue.

asymptomatic

(A-simp-toh-matic) not having any symptoms of a disease. Many cancers can develop and grow without producing symptoms, especially in the early stages. Screening tests such as mammograms help to find these early cancers, when the chances for cure are usually highest. (See also screening.)

mesothelioma

a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.

pemetrexed

chemotheraputic agent that interferes with a crucial process that allows cancer cells to reproduce and spread. Specifically, pemetrexed stops the production of three enzymes that are required to feed the cancer cell. Often used in combination with cisplatin. Marketed under the name ALIMTA. See: Alimta.

pleural effusion

an abnormal accumulation of fluid, usually caused by trauma or disease, in the pleural space.

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