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Mesothelioma

  • Vangelis Karamitrousis
  • Nikolaos Tsoukalas
Chapter

Abstract

Malignant pleural mesothelioma (MPM) is a rare cancer, linked to asbestos exposure. The median age at diagnosis is 70 years, however it can develop in younger patients. Poor prognostic factors include: pleural disease extent, high lactate dehydrogenase, poor performance status, high platelet count, non-epithelial histology, and old age. The key inactivated driver genes are CDKN2A, NF2 and BAP1. The most common symptom is dyspnea. Pleural effusion is present in most cases of MPM, revealed by a chest X-ray. Other diagnostic procedures include ultrasonography, computed tomgraphy, pleural effusion cytology, fluorodeoxyglucose-positron emission tomography and magnetic resonance imaging. There are three major histological subtypes of MPM: epithelioid, sarcomatoid and biphasic. Treatment of MPM includes surgery, radiotherapy and systemic therapy. Thoracoscopy aids in the diagnosis and management of MPM, especially in patients with large pleural effusions. Extrapleural pneumonectomy, pleurectomy and decortication, and palliative limited pleurectomy are the surgical operations used in the treatment of MPM. There is little benefit to adding radiotherapy to other treatments. The most common used systemic therapy regimens include a combination doublet of cisplatin, with an antifolate.

Keywords

Mesothelioma Asbestos Trimodality therapy 

Abbreviations

(c)Gy

(Centi) Gray

ACS

Active symptoms control

BAP-1

BRCA-1 associated protein-1

CDKN2A/ARF

Cyclin-dependent kinase inhibitor 2A/alternative reading frame

CEA

Carcinoembryonic antigen

CK

Cytokeratin

CT

Computer tomography

DVT

Deep venous thrombosis

ECOG

Eastern Cooperative Oncology Group

EF

Ejection fraction

FDG-PET

Fludeoxy-glucose positron emission tomography

FEV1

Forced expiratory volume in the first second

IL-1β

Interleukin-1β

IMRT

Intensity-modulated radiotherapy

MPM

Malignant pleural mesothelioma

MRI

Magnetic resonance imaging

MVP

Mitomycin, vinblastin, cisplatin

NF-2

Neurofibromatosis type-2

NSCLC

Non-small cell lung cancer

ORR

Overall response rate

OS

Overall survival

P/D

Pleurectomy and decortication

PPO

Predicted postoperative

PS

Performance status

RT

Radiotherapy

SV-40

Simian virus 40

TNF-α

Tumor necrosis factor-α

TNM

Tumor, nodal and metastasis

TTF-1

Thyroid transcription factor-1

US

Ultrasound

WT-1

Wilm’s tumor gene product

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Vangelis Karamitrousis
    • 1
  • Nikolaos Tsoukalas
    • 2
  1. 1.Medical Oncology DepartmentUniversity General Hospital of EvrosAlexandroupolisGreece
  2. 2.Oncology Clinic, 401 General Military HospitalAthensGreece

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