Types of surgery post-neoadjuvant chemotherapy for pleural mesothelioma.

Types of surgery post-neoadjuvant chemotherapy for pleural mesothelioma. Expert Rev Respir Med. 2019 Oct 09;: Authors: Kuribayashi K, Doi H, Kijima T Abstract Introduction: The surgical arm of the Mesothelioma and Radical Surgery (MARS) trial involved a multimodal approach, with combined therapy consisting of chemotherapy, complete gross resection, and radiation therapy. However, the MARS trial did not compare surgery with chemotherapy, and the survival and quality of life outcomes of this trial's surgical arm were inferior to those of the non-surgical arm. Methods for achieving complete gross resection (macroscopic complete response [MCR]) include extrapleural pneumonectomy (EPP), wherein the pleura, lung, diaphragm, and pericardium are removed en bloc, and pleurectomy/decortication (P/D), wherein the affected lung is preserved. Nonetheless, the most effective therapy remains unclear. Areas covered: Here, surgery post-neoadjuvant chemotherapy for malignant pleural mesothelioma with either EPP or P/D has been discussed, along with trimodal and bimodal therapies. Expert opinion: With the development of post-P/D radiation therapy, it is currently possible to truly compare EPP with P/D. Moreover, R0 resection cannot be achieved with either EPP or P/D; thus, both must incorporate debulking, although the two procedures are largely incompatible. Therefore, there is a need to rebuild the status of surgery as a multimodal therapy. PMID: 31596628 [PubMed - as ...
Source: Expert Review of Respiratory Medicine - Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research

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Malignant pleural mesothelioma (MPM) is a locoregionally aggressive malignancy with dismal outcomes. Trimodality therapy including neoadjuvant chemotherapy, surgical resection, and adjuvant radiotherapy (RT) is associated with a survival benefit in selected patients.1,2 However, 50% to 60% of patients are unable to complete trimodality treatment —resection is deferred because of disease progression during chemotherapy, and RT is deferred because of postoperative complications.3 In their article in this issue of the Journal, Nelson and colleagues4 explore factors affecting the likelihood of returning to RT after surgi...
Source: The Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Commentary Source Type: research
Authors: Shohdy K, Abdel-Rahman O Abstract INTRODUCTION: Trimodality therapy (including surgery, chemotherapy and radiation therapy) represents an important management approach of early-stage malignant pleural mesothelioma (MPM). The oncological value, as well as the proper sequence of the three modalities, is still under investigations. Areas Covered: The article covers the timing of chemotherapy in the management plan either "neoadjuvant approach" or in the adjuvant setting. It evaluates also how to select patients for induction chemotherapy and how to assess the response to treatment. Expert Opinion: M...
Source: Expert Review of Respiratory Medicine - Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research
Intraoperative photodynamic therapy combined with novel proton radiation improved survival time significantly for recent patients with advanced-stage pleural mesothelioma. The study — the first to measure the impact of this combination — involved 10 consecutive patients treated at the University of Pennsylvania’s Abramson Cancer Center. The treatment regimen resulted in a 90 percent, two-year disease control rate and an impressive 30.3-month median overall survival from the time of diagnosis. All 10 patients were diagnosed before treatment began with stage 3 or stage 4 disease, which typically results in ...
Source: Asbestos and Mesothelioma News - Category: Environmental Health Authors: Source Type: news
CONCLUSIONS: The overall strength of the evidence gathered in this review is low and there is a lack of available evidence to support the use of radical multimodality therapy in routine clinical practice (particularly as one trial suggests greater harm). Given the added cost of multimodality treatment and the possible increase in risk of adverse effects, the lack of evidence of their effectiveness probably means that these interventions should currently be limited to clinical trials alone. PMID: 29309720 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
Currently, no consensus has yet been reached regarding the best treatment of resectable malignant pleural mesothelioma (MPM) (1). The importance of a macroscopically complete resection, given the poor clinical outcomes seen in some MPM studies of patients undergoing extrapleural pneumonectomy (EPP) (2), is controversial. The treatment options include the best supportive care, palliative chemotherapy/RT, and multimodal therapy with curative intent. In our institution, we are conducting the SMART (Surgery for Mesothelioma After RT) study, in which patients with resectable MPM receive neoadjuvant accelerated hemithoracic RT a...
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Tags: Feature Source Type: research
Targeting cancer stem cells (CSCs) holds promise to address key challenges of cancer treatment: chemo- and radiation therapy resistance, metastasis, and recurrence. Increased CSC abundance after neoadjuvant chemotherapy has been associated with a significantly worse outcome. Combining CSC-targeted agents with chemotherapy may lead to more durable response with increased overall survival.Focal adhesion kinase (FAK), a non-receptor tyrosine kinase, mediates signal transduction by integrins and growth factor receptors to regulate cellular adhesion, proliferation, migration, and survival. Several studies have demonstrated that...
Source: Molecular Cancer Therapeutics - Category: Cancer & Oncology Authors: Tags: Cancer Stem Cells: Poster Presentations - Proffered Abstracts Source Type: research
Conditions:   Mesothelioma;   Solitary Fibrous Tumor of the PleuraIntervention:   Sponsor:   Mayo ClinicRecruiting - verified November 2015
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
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