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General Thoracic and Cardiovascular Surgery

, Volume 56, Issue 7, pp 317–323 | Cite as

Malignant mesothelioma: current status and perspective in Japan and the world

  • Seiki Hasegawa
  • Fumihiro Tanaka
Current Topics Review Article

Abstract

Malignant pleural mesothelioma (MPM) is associated with a poor prognosis; and to make things worse, its incidence is increasing throughout the world. Surgical management of MPM is comprised of two aspects: diagnosis and resection. Surgical biopsy with thoracoscopy provides a higher yield but a higher rate of tumor cell seeding than blind biopsy. In some surgical cases, extended surgical staging with mediastinoscopy, laparoscopy, and contralateral thoracoscopy is required for the preoperative evaluation for resectablity. There are two types of surgical resection for MPM. Pleurectomy/decortication (P/D) involves removal of as much of the visceral, parietal, and pericardial pleura and the tumor as possible without removing the underlying lung. Because P/D is less radical but less invasive compared to extrapleural pneumonectomy (EPP), it can be tolerated by poor-risk patients. EPP comprises en bloc resection of visceral, parietal, and pericardial pleura and adjacent components such as ipsilateral lung, pericardium, and diaphragm, without opening the pleural cavity. EPP was considred a highly dangerous procedure with a surgical mortality of more than 30% decades ago, but its current operative mortality/morbidity rates are 4%–9% and 60%, respectively. As macroscopic complete resection is the primary goal of surgery for MPM because of its diffuse intrapleural growth, surgical resection alone is associated with poor survival. In this context, combination therapy with surgery plus chemotherapy and/or radiotherapy is currently considered the standard treatment for patients with respectable MPM. A national survey of EPP was conducted recently in Japan, and a few multicenter clinical trials will start soon.

Key words

Malignant pleural mesothelioma Pleurectomy Extrapleural pneumonectomy Chemotherapy Multimodality treatment 

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References

  1. 1.
    Ceresoli GL, Locati LD, Ferreri AJ, Cozzarini C, Passoni P, Melloni G, et al. Therapeutic outcome according to histologic subtype in 121 patients with malignant pleural mesothelioma. Lung Cancer 2001;34:279–287.CrossRefPubMedGoogle Scholar
  2. 2.
    British Thoracic Society Standards of Care Committee. BTS statement on malignant mesothelioma in the UK, 2007. Thorax 2007;62(suppl 2):1–19.Google Scholar
  3. 3.
    Robinson BW, Musk AW, Lake RA. Malignant mesothelioma. Lancet 2005;366:397–408.CrossRefPubMedGoogle Scholar
  4. 4.
    Murayama T, Takahashi K, Natori Y, Kurumatani N. Estimation of future mortality from pleural malignant mesothelioma in Japan based on an age-cohort model. Am J Ind Med 2006;49:1–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Nakano T, Chahinian AP, Shinjo M, Tonomura A, Miyake M, Togawa N, et al. Interleukin 6 and its relationship to clinical parameters in patients with malignant pleural mesothelioma. Br J Cancer 1998;77:907–912.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Leung AN, Muller NL, Miller RR. CT in differential diagnosis of diffuse pleural disease. AJR Am J Roentgenol 1990;154:487–492.CrossRefPubMedGoogle Scholar
  7. 7.
    Renshaw AA, Dean BR, Antman KH, Sugarbaker DJ, Cibas ES. The role of cytologic evaluation of pleural fluid in the diagnosis of malignant mesothelioma. Chest 1997;111:106–109.CrossRefPubMedGoogle Scholar
  8. 8.
    Boutin C, Rey F. Thoracoscopy in pleural malignant mesothelioma: a prospective study of 188 consecutive patients. Part 1. Diagnosis. Cancer 1993;72:389–393.CrossRefPubMedGoogle Scholar
  9. 9.
    Bueno R, Reblando J, Glickman J, Jaklitsch MT, Lukanich JM, Sugarbaker DJ. Pleural biopsy: a reliable method for determining the diagnosis but not subtype in mesothelioma. Ann Thorac Surg 2004;78:1774–1776.CrossRefPubMedGoogle Scholar
  10. 10.
    Agarwal PP, Seely JM, Matzinger FR, MacRae RM, Peterson RA, Maziak DE, et al. Pleural mesothelioma: sensitivity and incidence of needle track seeding after image-guided biopsy versus surgical biopsy. Radiology 2006;241:589–594.CrossRefPubMedGoogle Scholar
  11. 11.
    Thylen A, Hjerpe A, Martensson G. Hyaluronan content in pleural fluid as a prognostic factor in patients with malignant pleural mesothelioma. Cancer 2001;92:1224–1230.CrossRefPubMedGoogle Scholar
  12. 12.
    Baas P. Optimising survival in malignant mesothelioma. Lung Cancer 2007;57(suppl 2):S24–S29.CrossRefPubMedGoogle Scholar
  13. 13.
    Rusch VW. A proposed new international TNM staging system for malignant pleural mesothelioma from the International Mesothelioma Interest Group. Chest 1995;108:1122–1128.CrossRefPubMedGoogle Scholar
  14. 14.
    Edwards JG, Stewart DJ, Martin-Ucar A, Muller S, Richards C, Waller DA. The pattern of lymph node involvement influences outcome after extrapleural pneumonectomy for malignant mesothelioma. J Thorac Cardiovasc Surg 2006;131:981–987.CrossRefPubMedGoogle Scholar
  15. 15.
    Heelan RT, Rusch VW, Begg CB, Panicek DM, Caravelli JF, Eisen C. Staging of malignant pleural mesothelioma: comparison of CT and MR imaging. AJR Am J Roentgenol 1999;172:1039–1047.CrossRefPubMedGoogle Scholar
  16. 16.
    Truong MT, Marom EM, Erasmus JJ, Preoperative evaluation of patients with malignant pleural mesothelioma: role of integrated CT-PET imaging. J Thorac Imaging 2006;21:146–153.CrossRefPubMedGoogle Scholar
  17. 17.
    Yamamuro M, Gerbaudo VH, Gill RR, Jacobson FL, Sugarbaker DJ, Hatabu H. Morphologic and functional imaging of malignant pleural mesothelioma. Eur J Radiol 2007;64:356–366.CrossRefPubMedGoogle Scholar
  18. 18.
    Byrne M, Hillerdal G, Imaging, staging and response evaluation. Lung Cancer 2005;49(suppl 1):S25–S26.CrossRefPubMedGoogle Scholar
  19. 19.
    Flores RM. The role of PET in the surgical management of malignant pleural mesothelioma. Lung Cancer 2005;49(suppl 1):S27–S32.CrossRefPubMedGoogle Scholar
  20. 20.
    Francis RJ, Byrne MJ, van der Schaaf AA, Boucek JA, Nowak AK, Phillips M, et al. Early prediction of response to chemotherapy and survival in malignant pleural mesothelioma using a novel semiautomated 3-dimensional volume-based analysis of serial 18F-FDG PET scans. J Nucl Med 2007;48:1449–1458.CrossRefPubMedGoogle Scholar
  21. 21.
    Conlon KC, Rusch VW, Gillern S. Laparoscopy: an important tool in the staging of malignant pleural mesothelioma. Ann Surg Oncol 1996;3:489–494.CrossRefPubMedGoogle Scholar
  22. 22.
    Rice DC, Erasmus JJ, Stevens CW, Vaporciyan AA, Wu JS, Tsao AS, et al. Extended surgical staging for potentially resectable malignant pleural mesothelioma. Ann Thorac Surg 2005;80:1988–1992, discussion 92-3.CrossRefPubMedGoogle Scholar
  23. 23.
    Martin-Ucar AE, Nakas A, Edwards JG, Waller DA. Case-control study between extrapleural pneumonectomy and radical pleurectomy/decortication for pathological N2 malignant pleural mesothelioma. Eur J Cardiothorac Surg 2007;31:765–770, discussion 70–1.CrossRefPubMedGoogle Scholar
  24. 24.
    Alvarez JM, Ha T, Musk W, Robins P, Price R, Byrne MJ. Importance of mediastinoscopy, bilateral thoracoscopy, and laparoscopy in correct staging of malignant mesothelioma before extrapleural pneumonectomy. J Thorac Cardiovasc Surg 2005;130:905–906.CrossRefPubMedGoogle Scholar
  25. 25.
    Van Ruth S, Baas P, Zoetmulder FA. Surgical treatment of malignant pleural mesothelioma: a review. Chest 2003;123:551–561.CrossRefPubMedGoogle Scholar
  26. 26.
    Cameron RB. Extrapleural pneumonectomy is the preferred surgical management in the multimodality therapy of pleural mesothelioma: con argument. Ann Surg Oncol 2007;14:1249–1253.CrossRefPubMedGoogle Scholar
  27. 27.
    Sugarbaker DJ. Macroscopic complete resection: the goal of primary surgery in multimodality therapy for pleural mesothelioma. J Thorac Oncol 2006;1:175–176.CrossRefPubMedGoogle Scholar
  28. 28.
    Flores RM, Zakowski M, Venkatraman E, Krug L, Rosenzweig K, Dycoco J, et al. Prognostic factors in the treatment of malignant pleural mesothelioma at a large tertiary referral center. J Thorac Oncol 2007;2:957–965.CrossRefPubMedGoogle Scholar
  29. 29.
    Treasure T, Sedrakyan A. Pleural mesothelioma: little evidence, still time to do trials. Lancet 2004;364:1183–1185.CrossRefPubMedGoogle Scholar
  30. 30.
    Treasure T, Utley M. Ten traps for the unwary in surgical series: a case study in mesothelioma reports. J Thorac Cardiovasc Surg 2007;133:1414–1418.CrossRefPubMedGoogle Scholar
  31. 31.
    Treasure T, Duffy N, Tan C, Peckitt C, Coombes G. The Mesothelioma and Radical Surgery (MARS) trial update. Lung Cancer 2006;54(suppl 1):44a.CrossRefGoogle Scholar
  32. 32.
    Rice D. Reply to Aelony. Ann Thorac Surg 2006;82:233.Google Scholar
  33. 33.
    Aelony Y. Staging in malignant mesothelioma. Ann Thorac Surg 2006;82:2337.CrossRefPubMedGoogle Scholar
  34. 34.
    Sugarbaker DJ. Editorial comment. Eur J Cardiothorac Surg 2007;31:770–771.CrossRefGoogle Scholar
  35. 35.
    Sugarbaker DJ, Flores RM, Jaklitsch MT, Richards WG, Strauss GM, Corson JM, et al. Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg 1999;117:54–63, discussion 63-5.CrossRefPubMedGoogle Scholar
  36. 36.
    Rusch VW. Pleurectomy/decortication in the setting of multimodality treatment for diffuse malignant pleural mesothelioma. Semin Thorac Cardiovasc Surg 1997;9:367–372.PubMedGoogle Scholar
  37. 37.
    Soysal O, Karaoglanoglu N, Demiracan S, Topcu S, Tastepe I, Kaya S, et al. Pleurectomy/decortication for palliation in malignant pleural mesothelioma: results of surgery. Eur J Cardiothorac Surg 1997;11:210–213.CrossRefPubMedGoogle Scholar
  38. 38.
    Grossebner MW, Arifi AA, Goddard M, Ritchie AJ. Mesothelioma: VATS biopsy and lung mobilization improves diagnosis and palliation. Eur J Cardiothorac Surg 1999;16:619–623.CrossRefPubMedGoogle Scholar
  39. 39.
    Ceresoli GL, Gridelli C, Santoro A. Multidisciplinary treatment of malignant pleural mesothelioma. Oncologist 2007;12:850–863.CrossRefPubMedGoogle Scholar
  40. 40.
    Sugarbaker DJ, Strauss GM, Lynch TJ, Richards W, Mentzer SJ, Lee TH, et al. Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma. J Clin Oncol 1993;11:1172–1178.PubMedGoogle Scholar
  41. 41.
    Krug LM, Pass H, Rusch VW, Kindler HL, Sugarbaker D, Rosenzweig K, et al. A multicenter U.S. trial of neoadjuvant pemetrexed plus cisplatin (PC) followed by extrapleural pneumonectomy (EPP) and hemithoracic radiation (RT) for stage I–III malignant pleural mesothelioma (MPM). J Clin Oncol 2007;18S:7561.Google Scholar
  42. 42.
    Chang M, Sugarbaker DJ. Technique of extrpleural pneumonectomy for diffuse malignant pleural mesothelioma. In: Shields TW, editor. General thoracic surgery. 6th edition. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 922–929.Google Scholar
  43. 43.
    Argote-Greene LM, Chang MY, Sugarbaker DJ. Extrapleural pneumonectomy for malignant pleural mesothelioma. MMCTS 2005 (http://mmcts.ctsnetjournals.org)/cgi/content/full/2005/0628/mmcts.2004.000133.
  44. 44.
    Sugarbaker DJ, Jaklitsch MT, Bueno R, Richards W, Lukanich J, Mentzer SJ, et al. Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies. J Thorac Cardiovasc Surg 2004;128:138–146.CrossRefPubMedGoogle Scholar
  45. 45.
    Opitz I, Kestenholz P, Lardinois D, Muller M, Rousson V, Schneiter D, et al. Incidence and management of complications after neoadjuvant chemotherapy followed by extrapleural pneumonectomy for malignant pleural mesothelioma. Eur J Cardiothorac Surg 2006;29:579–584.CrossRefPubMedGoogle Scholar
  46. 46.
    Flores RM. Induction chemotherapy, extrapleural pneumonectomy, and radiotherapy in the treatment of malignant pleural mesothelioma: the Memorial Sloan-Kettering experience. Lung Cancer 2005;49(suppl 1):S71–S74.CrossRefPubMedGoogle Scholar
  47. 47.
    Rusch VW, Rosenzweig K, Venkatraman E, Leon L, Raben A, Harrison L, et al. A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2001;122:788–795.CrossRefPubMedGoogle Scholar
  48. 48.
    Byrne MJ, Davidson JA, Musk AW, Dewar J, van Hazel G, Buck M, et al. Cisplatin and gemcitabine treatment for malignant mesothelioma: a phase II study. J Clin Oncol 1999;17:25–30.PubMedGoogle Scholar
  49. 49.
    Van Haarst JM, Baas P, Manegold C, Schouwink JH, Burgers JA, de Bruin HG, et al. Multicentre phase II study of gemcitabine and cisplatin in malignant pleural mesothelioma. Br J Cancer 2002;86:342–345.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Weder W, Kestenholz P, Taverna C, Bodis S, Lardinois D, Jerman M, et al. Neoadjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma. J Clin Oncol 2004;22:3451–3457.CrossRefPubMedGoogle Scholar
  51. 51.
    Vogelzang NJ, Rusthoven JJ, Symanowski J, Denham C, Kaukel E, Ruffie P, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 2003;21:2636–2644.CrossRefPubMedGoogle Scholar
  52. 52.
    Rusch VW. Pemetrexed and cisplatin for malignant pleural mesothelioma: a new standard of care? J Clin Oncol 2003;21:2629–2630.CrossRefPubMedGoogle Scholar
  53. 53.
    Rice DC, Stevens CW, Correa AM, Vaporciyan AA, Tsao A, Forster KM, et al. Outcomes after extrapleural pneumonectomy and intensity-modulated radiation therapy for malignant pleural mesothelioma. Ann Thorac Surg 2007;84:1685–1692, discussion 92-3.CrossRefPubMedGoogle Scholar
  54. 54.
    Allen AM, Czerminska M, Janne PA, Sugarbaker DJ, Bueno R, Harris JR, et al. Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelioma. Int J Radiat Oncol Biol Phys 2006;65:640–645.CrossRefPubMedGoogle Scholar
  55. 55.
    Neragi-Miandoab S. Multimodality approach in management of malignant pleural mesothelioma. Eur J Cardiothorac Surg 2006;29:14–19.CrossRefPubMedGoogle Scholar
  56. 56.
    Hasegawa S, Tanaka F, Okada M, Nakano T. Current status of multi-modality treatment for malignant pleural mesothelioma in Japan (in press).Google Scholar
  57. 57.
    Takagi K, Tsuchiya R, Watanabe Y, Surgical approach to pleural diffuse mesothelioma in Japan. Lung Cancer 2001;31:57–65.CrossRefPubMedGoogle Scholar
  58. 58.
    Higashiyama M, Morinaga K. Survey of surgical treatment of malignant pleural mesothelioma in Japan. Kyobu Geka 2007;60:19–24.PubMedGoogle Scholar
  59. 59.
    Okada M, Mimura T, Ohbayashi C, Sakuma T, Soejima T, Tsubota N. Radical surgery for malignant pleural mesothelioma: results and prognosis. Interact Cardiovasc Thorac Surg 2008;7:102–106.CrossRefPubMedGoogle Scholar
  60. 60.

Copyright information

© The Japanese Association for Thoracic Surgery 2008

Authors and Affiliations

  1. 1.Department of Thoracic SurgeryHyogo College of MedicineNishinomiyaJapan

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