LOCALIZED MALIGNANT MESOTHELIOMA STAGE

Treatment options:[1]

Standard:

1. Solitary mesotheliomas: Surgical resection en bloc including contiguous structures to ensure wide disease-free margins. Sessile polypoid lesions should be treated with surgical resection to ensure maximal potential for cure.[2]
2. Intracavitary mesothelioma: A. Palliative surgery (pleurectomy and decortication) with or without postoperative radiation therapy B. Extrapleural pneumonectomy C. Palliative radiation therapy

Under clinical evaluation:

1. Intracavitary chemotherapy following resection.[3,4]
2. Multimodality therapy.[4-6]
3. Other clinical trials.

References:

1. Antman KH, Li FP, Osteen R, et al.: Mesothelioma. Cancer: Principles and Practice of Oncology Updates 3(1): 1-16, 1989.

2. Martini N, McCormack PM, Bains MS, et al.: Pleural mesothelioma. Annals of Thoracic Surgery 43(1): 113-120, 1987.

3. Markman M, Kelsen D: Efficacy of cisplatin-based intraperitoneal chemotherapy as treatment of malignant peritoneal mesothelioma. Journal of Cancer Research and Clinical Oncology 118(7): 547-550, 1992.

4. Rusch V, Saltz L, Venkatraman E, et al.: A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma. Journal of Clinical Oncology 12(6): 1156-1163, 1994.

5. Sugarbaker DJ, Mentzer SJ, DeCamp M, et al.: Extrapleural pneumonectomy in the setting of a multimodality approach to malignant mesothelioma. Chest 103(4, Suppl): 377s-381s, 1993.

6. Vogelzang NJ: Malignant mesothelioma: diagnostic and management strategies for 1992. Seminars in Oncology 19(4, Suppl 11): 64-71, 1992.

ADVANCED MALIGNANT MESOTHELIOMA (STAGES II, III, AND IV)

Treatment options:

1. Symptomatic treatment to include drainage of effusions, chest tube pleurodesis, or thoracoscopic pleurodesis.[1]
2. Palliative surgical resection in selected patients.[2,3]
3. Palliative radiation therapy.[4,5]
4. Single-agent chemotherapy. Partial responses have been reported with doxorubicin,epirubicin, mitomycin, cyclophosphamide, cisplatin, carboplatin, and ifosfamide.[6-8]
5. Multimodality clinical trials.[9-13]
6. Intracavitary therapy. Intrapleural or intraperitoneal administration of chemotherapeutic agents (e.g., cisplatin, mitomycin, and cytarabine) has been reported to produce transient reduction in the size of tumor masses and temporary control of effusions in small clinical studies.[14-16] Additional studies are needed to define the role of intracavitary therapy.

References:

1. Boutin C, Viallat JR, Rey R: Thoracoscopy in Diagnosis, Prognosis and Treatment of Mesothelioma. In: Antman K, Aisner J, Eds.: Asbestos-Related Malignancy. Orlando: Grune & Stratton, 1987, pp: 301-321.

2. Butchart EG, Ashcroft T, Barnsley WC, et al.: The role of surgery in diffuse malignant mesothelioma of the pleura. Seminars in Oncology 8(3): 321-328, 1981.

3. Martini N, McCormack PM, Bains MS, et al.: Pleural mesothelioma. Annals of Thoracic Surgery 43(1): 113-120, 1987.

4. Bissett D, Macbeth FR, Cram I: The role of palliative radiotherapy in malignant mesothelioma. Clinical Oncology (Royal College of Radiologists) 3(6): 315-317, 1991.

5. Ball DL, Cruickshank DG: The treatment of malignant mesothelioma of the pleura: review of a 5-year experience, with special reference to radiotherapy. American Journal of Clinical Oncology 13(1): 4-9, 1990.

6. Chahinian AP, Antman K, Goutsou M, et al.: Randomized phase II trial of cisplatin with mitomycin or doxorubicin for malignant mesothelioma by the Cancer and Leukemia Group B. Journal of Clinical Oncology 11(8): 1559-1565, 1993.

7. Ong ST, Vogelzang NJ: Chemotherapy in malignant pleural mesothelioma: a review. Journal of Clinical Oncology 14(3): 1007-1017, 1996.

8. Lerner HJ, Schoenfeld DA, Martin A, et al.: Malignant mesothelioma: the Eastern Cooperative Group (ECOG) experience. Cancer 52(11): 1981-1985, 1983.

9. Mattson K, Holsti LR, Tammilehto L, et al.: Multimodality treatment programs for malignant pleural mesothelioma using high-dose hemithorax irradiation. International Journal of Radiation Oncology, Biology, Physics 24(4): 643-650, 1992.

10. Weissmann LB, Antman KH: Incidence, presentation and promising new treatments for malignant mesothelioma. Oncology (Huntington NY) 3(1): 67-72, 1989.

11. Vogelzang NJ: Malignant mesothelioma: diagnostic and management strategies for 1992. Seminars in Oncology 19(4, Suppl 11): 64-71, 1992.

12. Sugarbaker D, Harpole D, Healey E, et al.: Multimodality treatment of malignant pleural mesothelioma (MPM): results in 94 consecutive patients. Proceedings of the American Society of Clinical Oncology 14: A-1083, 356, 1995.

13. Sugarbaker DJ, Mentzer SJ, DeCamp M, et al.: Extrapleural pneumonectomy in the setting of a multimodality approach to malignant mesothelioma. Chest 103(4, Suppl): 377s-381s, 1993.

14. Markman M, Kelsen D: Efficacy of cisplatin-based intraperitoneal chemotherapy as treatment of malignant peritoneal mesothelioma. Journal of Cancer Research and Clinical Oncology 118(7): 547-550, 1992.

15. Markman M, Cleary S, Pfeifle C, et al: Cisplatin administered by the intracavitary route as treatment for malignant mesothelioma. Cancer 58(1): 18-21, 1986.

16. Rusch VW, Figlin R, Godwin D, et al.: Intrapleural cisplatin and cytarabine in the management of malignant pleural effusions: a Lung Cancer Study Group trial. Journal of Clinical Oncology 9(2): 313-319, 1991.