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What follows are articles / studies on the following: [hyperlink down to the below articles] 1. Pleural Mesothelioma or Diffuse Malignant Mesothelioma Articles / Studies on Pleural Mesothelioma or Diffuse Malignant MesotheliomaTRI-MODALITY THERAPY FOR PLEURAL MESOTHELIOMA (Diffuse Malignant Mesothelioma) Eric Vallieres MD, Douglas Wood MD, Riyad Karmy-Jones MD, Robert Livingston MD, Karen Hunt MD, Keith Stelzer MD. Introduction: Extrapleural pneumonectomy (EPP) remains the most effective therapeutic modality to locally control DMM but both systemic and local recurrences are common. The addition of effective chemotherapy and radiation therapy to EPP could potentially improve both local and systemic control and improve survival. This trial evaluates the feasibility of induction cisplatin methotrexate and vinblastine chemotherapy (PMV), EPP and adjuvant neutron radiotherapy (NRT) in the treatment of DMM. Methods: Patients with clinical stages I-III DMM, Karnofsky 80% or better and who have adequate pulmonary reserves receive induction PMV followed by EPP and adjuvant whole hemithorax NRT. Data is collected prospectively. Results: Eight patients (7M, 1F), ages 51 to 68, stages I (3), II (2) and III (3) have initiated this protocol. Three patient are completing induction PMV. In the other 5, a clinical response to PMV was seen in 3 patients. Five patients have undergone EPP (4 right, 1 left) and all 5 had positive microscopic margins. There were 3 epithelial DMM and 2 mixed type, pathological stages III (3) and IV (2). There was no operative mortality and hospital stays ranged from 6 to 10 days. Delayed morbidity was major in 3 patients. Four patients have completed adjuvant NRT and 3 remain free of disease at 19, 16 and 5 months. Conclusion: Induction PMV, EPP and FNRT. appears feasible and safe in this early experience. Multimodality Approach to Diffuse Malignant Mesothelioma (DMM) of the Pleura A Phase II Prospective Trial UWMC-97 Articles / Case Studies on Peritoneal Mesothelioma Peritoneal mesothelioma in a 17-year-old boy with evidence of previous exposure to chrysotile and tremolite asbestos. Abstract: We describe a case of malignant peritoneal mesothelioma arising in a 17-year-old boy. The diagnosis was based on a comprehensive study including light microscopy, histochemistry, immunohistochemistry, evaluation of the clinical course, and autopsy examination. Analytical transmission electron microscopy showed a concentration of 510,000 asbestos fibers/g dry lung tissue. The fibers were represented by chrysotile (62%) and tremolite (38%) asbestos. About 40% of the total fibers were longer than 5 microns. The presence of tremolite fibers was probably due to environmental exposure to contaminated cosmetic talc. This is the first reported case of pathologically proven exposure to asbestos dust in malignant mesothelioma of childhood and adolescence. Andrion A and Bosia S Division of Pathological Anatomy, City Hospital, Asti, Italy. Hum Pathol 1994 Jun, vol. 25, pages 617-622 UNITED STATES Intraperitoneal cisplatin and etoposide in peritoneal mesothelioma: favorable outcome with a multimodality approach. Abstract: Ten patients with histologically documented peritoneal mesothelioma were treated with intraperitoneal cisplatin 200 mg/m2, sodium thiosulfate rescue and etoposide 65-290 mg/m2 every 4 weeks for a maximum of six cycles. All had epithelial or mixed epithelial-fibrous histology. Toxicity was tolerable, with 50% sustaining grade 3 or 4 granulocytopenia. There was one episode of neutropenic fever. Grade 2 peripheral neuropathy occurred in one patient, grade 1 in five patients. Complete remission occurred in one of five patients with measurable disease. Median survival for patients whose tumors were surgically debulked to < 2 cm residua prior to treatment was 22 months, while it was 5 months for those with measurable, surgically inaccessible disease (P = 0.0731 by Cox regression proportional hazard model). These data suggest that patients who present with resectable disease may benefit from an aggressive adjuvant approach. This possibility warrants prospective testing in a randomized clinical trial. Langer CJ and Rosenblum N Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111. Cancer Chemother Pharmacol 1993, vol. 32, pages 204-208 GERMANY Intestinal obstruction due to diffuse peritoneal fibrosis at 2 years after the successful treatment of malignant peritoneal mesothelioma with intraperitoneal mitoxantrone [published erratum appears in Cancer Chemother Pharmacol 1992;30(3):249] Abstract: A 44-year-old man who had achieved a complete remission of malignant peritoneal mesothelioma after the intraperitoneal administration of 25mg/m2 mitoxantrone presented with clinical and radiological signs of intestinal obstruction suggestive of recurrent disease at about 2 years following the initial treatment. However, laparotomy revealed extensive adhesive fibrosis but no sign of malignant mesothelioma. The peritoneal complications of intraperitoneal cytostatic treatment are discussed. Vlasveld LT and Taal BG Department of Medical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Huis, Amsterdam. Cancer Chemother Pharmacol 1992, vol. 29, pages 405-408 GERMANY Malignant peritoneal mesothelioma in childhood with long-term survival. Abstract: A diffuse, well-differentiated, malignant peritoneal mesothelioma (MPM) developed in a nine-year-old girl. She received limited chemotherapy and radiation therapy and is alive and well without clinical evidence of disease 109 months after diagnosis. The neoplastic cells stained immunohistochemically for cytokeratin and epithelial membrane antigen but were unreactive with B72.3, anti-carcinoembryonic antigen, and anti-Leu-M1. Ultrastructurally, the tumor cells had abundant desmosomes, numerous tonofilament bundles, and variable-length microvilli. These findings confirm the mesothelial nature of the cells. Features consistent with malignancy included DNA aneuploidy by flow cytometric analysis and diffuse peritoneal involvement. The three previously described survivors with MPM were also premenarchal girls. Some MPMs in premenarchal girls have an indolent biologic behavior similar to that of low-grade peritoneal serous neoplasia or well-differentiated papillary mesothelioma in adult women. Geary WA, Mills SE and Frierson HF, Jr Department of Pathology, University of Virginia Health Sciences Center, Charlottesville 22908. Am J Clin Pathol 1991 Apr, vol. 95, pages 493-498 Successful therapy of peritoneal mesothelioma with intraperitoneal chemotherapy alone. A case report. Abstract: Malignant peritoneal mesothelioma is a disease that remains relatively refractory to conventional intravenous chemotherapy with currently available agents. Single-agent and combination chemotherapy offer a response rate of 20%. Direct intraperitoneal administration of some chemotherapeutic agents results in a significant pharmacologic advantage with much greater area under the concentration versus time curve (AUC). We report a case of a patient with peritoneal mesothelioma treated with combination intraperitoneal cisplatin and Ara-C who achieved a pathologic complete remission. This patient is still alive and has been in complete remission for 53 months. This combination of intraperitoneal chemotherapy deserves further evaluation in malignant mesothelioma. Garcia Moore ML Section of Medical Oncology, University of Miami School of Medicine, Florida 33121. Am J Clin Oncol 1992 Dec, vol 15, pages 528-530 UNITED STATES Intraperitoneal chemotherapy for malignant peritoneal mesothelioma [published erratum appears in Eur J Cancer 1991;27(12):1717] Abstract: 4 patients with malignant peritoneal mesothelioma have been treated with intraperitoneal chemotherapy in the Netherlands Cancer Institute in the recent years. 1 patient achieved a complete remission for 36+ months and another patient had a partial remission that lasted for 10 months. Intraperitoneal chemotherapy alone or in combination with other treatment modalities may yield a response rate of 58% with 24% complete remissions in 70 patients reviewed in the literature. Although these data should be considered with caution because of the heterogenicity of the patient group treated, cisplatin-based intraperitoneal chemotherapy seems to be the best available treatment for malignant peritoneal mesothelioma at present. Vlasveld LT Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam. Eur J Cancer 1991, vol. 27, pages 732-734 ENGLAND Efficacy of cisplatin-based intraperitoneal chemotherapy as treatment of malignant peritoneal mesothelioma. Abstract: In an effort to examine the potential clinical utility of intraperitoneal (i.p.) therapy in the management of patients with malignant peritoneal mesothelioma, 19 individuals with this disease were treated with a cisplatin-based i.p. treatment regimen. All but 1 patient also received i.p. mitomycin. The treatment was generally well tolerated, although a maximum of only four or five courses of cisplatin (100 mg/m2 every 28 days) and mitomycin (5-10 mg/treatment given 7 days after each i.p. cisplatin administration) could be administered, the treatment principally being stopped because of disease progression or catheter failure. Of 15 patients with malignant ascites, 7 (47%) experienced control of fluid reaccumulation ranging from 2 months to 73+ months (median 8 months). While the median survival for the 19 patients was only 9 months, 4 (21%) patients survived for more than 3 years from the initiation of therapy, and 2 patients are currently alive and clinically disease-free more than 5 years from the start of the i.p. treatment program. We conclude that a subset of patients with peritoneal mesothelioma, principally those with small-volume residual disease following surgical tumor debulking, can benefit from a cisplatin-based i.p. treatment strategy with control of ascites and prolonged disease-free survival. Markman M and Kelsen D Breast/Gynecology Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021. J Cancer Res Clin Oncol 1992, vol. 118, pages 547-550 GERMANY
Primary pericardial mesothelioma: Yuko Kobayashi1, , Ryusuke Murakami1, Junko Ogura1, Kanae Yamamoto1,
Taro Ichikawa1, Kouichi Nagasawa2, Masaru Hosone3 and Tatsuo Kumazaki4 Abstract. The imaging features of primary pericardial mesothelioma have rarely been described. Herein we present a case report of its diagnostic-pathologic features. Chest computed tomography (CT) revealed an irregularly enhanced mass occupying the entire pericardial space and surrounding the superior vena cava. At autopsy, the tumor was found to fill the pericardial space completely, and to extend to the superior vena cava through the superior pericardial sinus. The CT features of the tumor were correlated well with those revealed at autopsy, and provided satisfactory information regarding the presence and the extension of the tumor.
Desmoplastic malignant mesothelioma is the growth of fibrous or
connective tissues around the tumor of the lining of the lung or
chest cavity. The term "desmoplastic" refers to the growth
of fibrous or connective tissue. "Desmo-" comes from the
Greek "desmos" meaning "a fetter or band" and
"-plastic" is also borrowed from the Greek, from "plassein"
meaning "to form" = to form a band or fetter Packet No.: 4
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