Mesothelioma Diagnosis

Another interesting study is called, Positron emission tomography predicts survival in malignant pleural Mesothelioma – Volume 132, Issue 4, Pages 763-768 (October 2006) Presented in part at the 39th American Society of Clinical Oncology meeting, Chicago, Illinois, May 31June 3, 2003 by Raja M. Flores, MD, Timothy Akhurst, MD, Mithat Gonen, PhD, Maureen Zakowski, MD, Joseph Dycoco, BA, Steven M. Larson, MD, Valerie W. Rusch, MD Here is an excerpt: Recent studies suggest that standard uptake value on fluorodeoxyglucose positron emission tomography scan can predict mediastinal lymph node status in malignant pleural mesothelioma. Because mediastinal nodal metastasis is known to be associated with poor prognosis, we hypothesized that standard uptake value on fluorodeoxyglucose positron emission tomography might independently predict survival. Methods – Patients with pathologically proven mesothelioma underwent fluorodeoxyglucose positron emission tomography scanning. Patients fasted and received a minimum of 10 mCi of F18-fluorodeoxyglucose. Whole-body emission studies were acquired, followed by whole-body transmission scans with iterative reconstruction. On the basis of the maximal chi-square method, a standard uptake value of 10 was chosen to classify patients as low versus high standard uptake value. Survival probabilities for both standard uptake value groups were estimated by the Kaplan-Meier method. A Cox proportional hazards model assessed the joint influence of standard uptake value, histology, and stage on survival.

Results – From 1998 to 2005, 137 patients with malignant pleural mesothelioma underwent positron emission tomography scans. The median follow-up for all surviving patients was 24 months. Median survivals were 9 and 21 months for the high and low standard uptake value groups, respectively (P = .02). In a multivariable analysis, high standard uptake value tumors were associated with a 1.9 times greater risk of death than low standard uptake value tumors (P

Conclusions – Standard uptake value greater than 10, mixed histology, and stages III and IV are poor risk factors in malignant pleural mesothelioma. These findings suggest that fluorodeoxyglucose positron emission tomography can be used to stratify patients for treatment and clinical trials.

Another study is called, A phase I study of Foscan-mediated photodynamic therapy and surgery in patients with Mesothelioma – The Annals of Thoracic Surgery – Volume 75, Issue 3, March 2003, Pages 952-959 – Joseph S. Friedberg MD, , a, Rosemarie Mick MS, James Stevenson MD, James Metz MD, Timothy Zhu PhD, Jo Buyske MD, Daniel H. Sterman MD, Harvey I. Pass MD, Eli Glatstein MD and Stephen M. Hahn MD Here is an excerpt: Abstract Background – Photodynamic therapy (PDT) is a light-based cancer treatment that, in the correct setting, can be delivered intraoperatively as an adjuvant therapy. A phase I clinical trial combining surgical debulking with Foscan-mediated PDT was performed in patients with malignant pleural mesothelioma. The purpose of the study was to define the toxicities and to determine the maximally tolerated dose (MTD) of Foscan-mediated PDT. Methods – A total of 26 patients completed treatment. Tumor debulking was accomplished with either an extrapleural pneumonectomy (7 patients) or a lung-sparing pleurectomydecortication (19 patients). Patients were injected with Foscan before surgery, and 652 nm light was delivered intraoperatively after completion of surgical debulking. Four light sensors were placed in the chest, allowing delivery of light to a uniform measured dose throughout the hemithorax.

Results – Four dose levels were explored. The MTD was 0.1 mg/kg of Foscan injected 6 days before surgery in combination with 10 J cm2 652 nm light. Dose limiting toxicity at the next higher dose was a systemic capillary leak syndrome leading to death in 2 of 3 patients treated at that dose. Other PDT-related toxicities included wound burns and skin photosensitivity. In all, 14 patients were treated at the MTD without significant complications.

Conclusions – Foscan-mediated PDT can be safely combined with surgery at the established MTD. Unlike most other surgery-based multimodal treatments for mesothelioma, Foscan-mediated PDT affords the option, in selected patients, of accomplishing tumor debulking with a lung-sparing procedure rather than an extrapleural pneumonectomy. A phase II study is warranted.