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.
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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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Karamitrousis, V., Tsoukalas, N. (2019). Mesothelioma. In: De Mello, R., Mountzios, G., Tavares, Á. (eds) International Manual of Oncology Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-16245-0_11
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