Mesothelioma Tumor Volumes and Survival Predictions

Mesothelioma Tumor Volumes and Survival Predictions

Another interesting study is called, “Preoperative Tumor Volume Is Associated With Outcome In Malignant Pleural Mesothelioma” by Harvey I. Pass, MD, Barbara K. Temeck, MD, Karen Kranda, RN, Seth M. Steinberg, PhD, Irwin R. Feuerstein, MD – From the Thoracic Oncology Section,a Biostatistics and Data Management Section,b National Cancer Institute, Diagnostic Radiology Department,c Warren Magnusen Clinical Center, National Institutes of Health, Bethesda, Md. GENERAL THORACIC SURGERY – J Thorac Cardiovasc Surg 1998;115:310-318.  Here is an excerpt: “Objectives: Our objective was to analyze the impact of preoperative and postresection solid tumor volumes on outcomes in 47 of 48 consecutive patients undergoing resection for malignant pleural mesothelioma who were treated prospectively and randomized to photodynamic therapy or no photodynamic therapy.   Methods: From July 1993 to June 1996, 48 patients with malignant pleural mesothelioma had cytoreductive debulking to 5 mm or less residual tumor by extrapleural pneumonectomy (n = 25) or leurectomy/decortication (n = 23). Three-dimensional computed tomographic reconstructions of preresection and postresection solid tumor were prospectively performed and the disease was staged postoperatively according to the new International Mesothelioma Interest Group staging.   Results: Median survival for all patients is 14.4 months (extrapleural pneumonectomy, 11 months; pleurectomy/decortication, 22 months; p2 = 0.07). Median survival for preoperative volume less than 100 was 22 months versus 11 months if more than 100 cc, p2 = 0.03. Median survival for postoperative volume less than 9 cc was 25 months versus 9 months if more than 9 cc, p2 = 0.0002. Thirty-two of forty-seven (68%) had positive N1 or N2 nodes. Tumor volumes associated with negative nodes were significantly smaller (median 51 cc) than those with positive nodes (median 166 cc, p2 = 0.01). Progressively higher stage was associated with higher median preoperative volume: stage I, 4 cc; stage II, 94 cc; stage III, 143 cc; stage IV, 505 cc; p2 = 0.007 for stage I versus II versus III versus IV. Patients with preoperative tumor volumes greater than 52 cc had shorter progression-free intervals (8 months) than those 51 cc or less (11 months; p2 = 0.02).  Conclusions: Preresection tumor volume is representative of T status in malignant pleural mesothelioma and can predict overall and progression-free survival, as well as postoperative stage. Large volumes are associated with nodal spread, and postresection residual tumor burden may predict outcome.” (J Thorac Cardiovasc Sufg 1998;115:310-8)

Another interesting study is called, “Use of a “Replication-Restricted” Herpes Virus to Treat Experimental Human Malignant Mesothelioma” by John C. Kucharczuk1, Bruce Randazzo1, Michael Y. Chang, Kunjlata M. Amin, Ashraf A. Elshami, Daniel H. Sterman, Nabil P. Rizk, Katherine L. Molnar-Kimber, S. Moira Brown, Alasdair R. MacLean, Leslie A. Litzky, Nigel W. Fraser, Steven M. Albelda, and Larry R. Kaiser – Cancer Res February 1, 1997 57; 466 – Here is an excerpt: “Abstract – Modified, nonneurovirulent herpes simplex viruses (HSVs) have shown promise in the treatment of brain tumors. However, HSV-1 can infect and lyse a wide range of cell types. In this report, we show that HSV-1716, a mutant lacking both copies of the gene coding ICP-34.5, can effectively treat a localized i.p. malignancy. Human malignant mesothelioma cells supported the growth of HSV-1716 and were efficiently lysed in vitro. i.p. injection of HSV-1716 into animals with established tumor nodules reduced tumor burden and significantly prolonged survival in an animal model of non-central nervous system-localized human malignancy without dissemination or persistence after i.p. injection into SCID mice bearing human tumors. These findings suggest that this virus may be efficacious and safe for use in localized human malignancies of nonneuronal origin such as malignant mesothelioma.

Another interesting study is called, “Chemotherapy of diffuse malignant mesothelioma. Phase II trials of single-agent 5-fluorouracil and adriamycin” by Vernon J. Harvey MRCP, Dr. Maurice L. Slevin MRCP, Bruce A. J. Ponder PhD, MRCP, Anthony J. Blackshaw MA, MRCPath, Peter F. M. Wrigley PhD, FRCP – Cancer Volume 54, Issue 6, pages 961–964, 15 September 1984.  Here is an excerpt: “Abstract – Twenty consecutive patients with a confirmed diagnosis of diffuse malignant mesothelioma of the pleura or peritoneum, previously untreated with chemotherapy, were studied in a Phase II trial of single-agent 5-fluorouracil. One partial response of 24 months was seen. Eleven patients were treated with single-agent Adriamycin (doxorubicin) after progression on 5-fluorouracil, and one partial response of 34 months was seen. It is concluded that 5-fluorouracil has only minimal activity in diffuse malignant mesothelioma. Preliminary data suggest that Adriamycin has little activity as a second-line agent.”

We all owe a debt of gratitude to these fine researchers for their work.  If you found any of these excerpts helpful, please read the studies in their entirety.

 

Monty Wrobleski is the author of this article.  For more information please click on the following links

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