Quoted from http://jco.ascopubs.org/content/30/13/1541.abstract?maxtoshow=&HITS=10&hits=1&RESULTFORMAT=&andorexacttitle=or&andorexacttitleabs=and&fulltext=asbestos&andorexactfulltext=and&searchid=1&usestrictdates=yes&resourcetype=HWCIT&ct

Serum Mesothelin for Diagnosing Malignant Pleural Mesothelioma: An Individual Patient Data Meta-Analysis

1. Presented in part at the 10th International Congress of the International Mesothelioma Interest Group, August 31 to September 3, 2010, Kyoto, Japan.

Abstract

Purpose Mesothelin is currently considered the best available serum biomarker of malignant pleural mesothelioma. To examine the diagnostic accuracy and use of serum mesothelin in early diagnosis, we performed an individual patient data (IPD) meta-analysis.

Methods The literature search identified 16 diagnostic studies of serum mesothelin, measured with the Mesomark enzyme-linked immunosorbent assay. IPD of 4,491 individuals were collected, including several control groups and 1,026 patients with malignant pleural mesothelioma. Mesothelin levels were standardized for between-study differences and age, after which the diagnostic accuracy and the factors affecting it were examined with receiver operating characteristic (ROC) regression analysis.

Results At a common diagnostic threshold of 2.00 nmol/L, the sensitivities and specificities of mesothelin in the different studies ranged widely from 19% to 68% and 88% to 100%, respectively. This heterogeneity can be explained by differences in study population, because type of control group, mesothelioma stage, and histologic subtype significantly affected the diagnostic accuracy. The use of mesothelin in early diagnosis was evaluated by differentiating 217 patients with stage I or II epithelioid and biphasic mesothelioma from 1,612 symptomatic or high-risk controls. The resulting area under the ROC curve was 0.77 (95% CI, 0.73 to 0.81). At 95% specificity, mesothelin displayed a sensitivity of 32% (95% CI, 26% to 40%).

Conclusion In patients suspected of having mesothelioma, a positive blood test for mesothelin at a high-specificity threshold is a strong incentive to urge further diagnostic steps. However, the poor sensitivity of mesothelin clearly limits its added value to early diagnosis and emphasizes the need for further biomarker research.

Quoted from http://occmed.oxfordjournals.org/content/early/2012/04/26/occmed.kqs028.abstract?maxtoshow=&HITS=10&hits=3&RESULTFORMAT=&andorexacttitle=or&andorexacttitleabs=and&fulltext=asbestos&andorexactfulltext=and&searchid=1&usestrictdates=yes&resourcetype=HWCIT&ct

The presentation and natural history of asbestos-induced diffuse pleural thickening

1. V. Jeebun1 and
2. S. C. Stenton2

1. ? 1Department of Respiratory Medicine, University Hospital of North Tees, Stockton on Tees, TS19 8PE, UK
2. ? 2Regional Unit for Occupational Lung Disease, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4AP, UK.

• Received September 26, 2011.
• Revision received January 15, 2012.
• Accepted January 26, 2012.

Abstract

Background Three forms of asbestos-related benign pleural disease are recognized: discrete pleural plaques, pleural effusions and diffuse pleural fibrosis. Of these, diffuse pleural fibrosis is the most significant on account of its chronicity and associated morbidity.

Aims The objectives of this study were to determine the latency of asbestos-induced diffuse pleural fibrosis, its presenting features and its clinical course once established.

Methods We conducted a retrospective review of 75 patients with asbestos-induced diffuse pleural fibrosis referred for assessment at our institution from 1992 to 2007. Diffuse pleural fibrosis was considered to be present if there was obliteration of the costophrenic angle in continuity with at least 3-mm pleural thickening, in accordance with the International Labour Organization 2000 Classification.

Results The median latency for development of diffuse pleural fibrosis from first asbestos exposure was 34 years. Seventy-three per cent of patients had unilateral disease at presentation and 24% of these were observed to develop contralateral disease after a median of 2 years. Unilateral pleural disease was commonest on the right. Forty per cent of patients presented with pleural effusions preceding the development of diffuse pleural thickening. The median latency for development of pleural effusions from onset of exposures was 38 years. Eighty per cent of the pleural effusions were unilateral. Once established, pleural thickening was reported to have remained stable in 91% on the ipsilateral side.

Conclusions The findings of this study may help in providing further insight into the natural history of diffuse pleural fibrosis to guide the clinician in the management of this condition.

Quoted from http://highwire.stanford.edu/cgi/medline/pmid;22509441

Primary malignant pericardial mesothelioma presenting as acute pericarditis. WS Choi, MS Im, JH Kang, YG Kim, IC Hwang, JM Lee, S Lee, HS Shin, SP Lee, and GY Cho J Cardiovasc Ultrasound, March 1, 2012; 20(1): 57-9.   Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
We report on a 21-year-old man with fever, dyspnea, and pleuritic chest pain. An electrocardiography showed ST elevation in multiple lead and thoracic echocardiography revealed moderate pericardial effusion. He was initially diagnosed with acute pericarditis, and treated with nonsteroidal anti-inflammatory drugs and colchicines with clinical and laboratory improvement. After 1 month of medication, his symptoms recurred. An echocardiography showed constrictive physiology and the patient was treated with steroid on the top of current medication. The patient had been well for 7 months until dyspnea and edema developed, when an echocardiography showed marked increased pericardial thickness and constriction. Pericardial biopsy was performed and primary malignant pericardial mesothelioma was diagnosed. Malignancy should be considered in the differential diagnosis of recurrent pericarditis.

Quoted from http://highwire.stanford.edu/cgi/medline/pmid;22513792

Malignant Peritoneal Mesothelioma in a 16-Year-Old Girl: Presentation of a Rare Disease. IB Brecht, A Agaimy, M Besendorfer, R Carbon, FC Thiel, O Rompel, D Osinski, T Langer, M Metzler, and W Holter Klin Padiatr, April 18, 2012; . Pediatric Hematology and Oncology, University Hospital -Erlangen, Germany.
Malignant peritoneal mesothelioma is extremely rarely seen in young patients. A 16 year-old girl presented with appendicitis-like acute abdominal pain. Intra-operatively, multiple confluent peritoneal nodules were seen on the entire greater omentum and in the pelvis infiltrating the uterus and both ovaries. Biopsies were obtained and interpreted as serous ovarian carcinoma. Radical surgical resection and hyperthermic intraperitoneal chemotherapy -(HIPEC) with carboplatin was performed and followed by 2 cycles of carboplatin / paclitaxel. Histological reevaluation showed characteristic features of epithelioid peritoneal mesothelioma and ruled out serous ovarian cancer. Therapy was continued with 6 cycles of pemetrexed/cisplatin.3 months after end of chemotherapy vital tumor tissue was found in the recess behind the liver, which could be resected completely. The patient is currently disease-free 17 months after initial diagnosis. Malignant peritoneal mesothelioma in young female patients might be under-recognized and possibly misdiagnosed as ovarian serous carcinoma in some cases. International and interdisciplinary cooperation is necessary in order to provide evidence based guidelines for diagnosis and treatment in the future.

Quoted from http://www.medpagetoday.com/MeetingCoverage/ELCC/32298

RT May Have Role in Mesothelioma

ByCharles Bankhead, Staff Writer, MedPage Today

Published: April 22, 2012

 

GENEVA — Patients with advanced, poor-risk mesothelioma lived for as long as 7 years after treatment with high-dose, hemithoracic radiation therapy, data from a small patient series showed.

The 45 patients had a median overall survival of 12.4 months from treatment and an estimated 1-year survival of 50%. No patient had in field-only recurrent disease following treatment with conformal or intensity-modulated radiation therapy (IMRT).

The findings dispute the notion that mesothelioma is radiation insensitive, Malcolm Feigen, MD, said here at the European Lung Cancer Conference (ELCC).

“I stood before [the ELCC] 2 years ago to present the first 14 patients we had analyzed and asked whether there was a role for high-dose hemithoracic radiotherapy in unpneumonectomized mesothelioma patients,” said Feigen, of the Austin Health Radiation Oncology Center in Melbourne, Australia. “I think now that the answer to that question is ‘absolutely.’”

[Article continues at original source]

Quoted from http://www.news-medical.net/news/20120419/Developments-in-mesothelioma-treatment-presented-at-3rd-European-Lung-Cancer-Conference.aspx

Developments in mesothelioma treatment presented at 3rd European Lung Cancer Conference

Published on April 19, 2012 at 9:23 AM

Presentations at the 3rd European Lung Cancer Conference

New results presented at 3rd European Lung Cancer Conference in Geneva, Switzerland show important steps being made to improve the diagnosis and treatment of malignant pleural mesothelioma, an aggressive cancer of the outer lining of the lungs caused by asbestos exposure.

Micro RNAs speed diagnosis

Australian researchers have identified a small molecule that is more abundant in the blood of people with the deadly lung disease mesothelioma than in healthy people. Their findings bring scientists a step closer to being able to diagnose mesothelioma earlier than is currently possible.

At present diagnosing mesothelioma depends on the availability of a lung biopsy that contains enough tumor tissue. However suitable biopsies are not always available, which can leave doctors uncertain about the patient’s diagnosis, sometimes resulting in a delay to the start of treatment. “If doctors could use a diagnostic marker based on a simple blood test to help with diagnosis, it could circumvent the problem of availability of tumor tissue and help to accelerate the diagnostic process,” says Dr Michaela Kirschner from the Asbestos Diseases Research (Concord Hospital Campus) in Sydney, who reported the new findings.

So far a number of proteins have been proposed as blood-based markers for malignant pleural mesothelioma; however none of these has so far reached the accuracy required for routine clinical use.

[Article continues at original source]

Quoted from http://highwire.stanford.edu/cgi/medline/pmid;22493390

Complete Response and Long-term Survival in Malignant Pleural Mesothelioma: Case Report. S Takanen, B Resuli, V Graziano, A Parisi, R Lisi, N Raffetto, and V Tombolini Anticancer Res, April 1, 2012; 32(4): 1485-7.   Viale del Policlinico 326 00161, Italy. silvia_takanen@hotmail.com.
Malignant pleural mesothelioma is a rare tumour. A three-modal strategy, comprising of surgery, radiotherapy and chemotherapy has been shown to be essential for appropriate management. Current literature evidences the importance of radiation therapy in the adjuvant setting for local control of the disease, as part of a multidisciplinary treatment, with increment of progression-free survival rate, but also of disease-free survival. Case Report: At the beginning of 2007, a 26-year-old Peruvian woman was admitted to the hospital referring breathlessness and other non-specific symptoms such as fever and weight loss. After the diagnosis of pleural mesothelioma by thoracoscopic talc insufflation, combined with pleural biopsy, and total body computed tomographic scan, the patient underwent two cycles of neoadjuvant chemotherapy with pemetrexed (500 mg/m(2)) and cisplatin (75 mg/m(2)), followed by an extra-pleural pneumonectomy. After 6 months, the patient was treated with three-dimensional external beam radiation therapy to the left hemithorax. Computed tomographic scans, performed after the ending of the radiotherapy, integrated with positron-emission tomography, were all negative for neoplastic pathology. The patient remains in good health and free from recurrence at four years. CONCLUSION: This clinical case shows a disease-free survival interval of 4 years for malignant pleural mesothelioma. A good staging system and a combined treatment, involving surgery, neoadjuvant chemotherapy and adjuvant radiation therapy, represent a useful strategy not only to contain local disease progression, but even to increase disease-free survival in pleural mesothelioma.