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Mesothelioma
Treatment
Articles
and Abstracts
Treatment
of malignant mesothelioma.
World
J Surg 2001 Feb;25(2):210-7
Jaklitsch
MT, Grondin SC, Sugarbaker DJ.
Department
of Surgery, Division of Thoracic Surgery,
Brigham and Women's Hospital, 75 Francis
Street, Boston, Massachusetts 02115,
USA.
Malignant
pleural mesothelioma (MPM) is a rare tumor
that predominantly afflicts men over 50
years of age. Nearly 3000 MPMs are
reported annually in the United States
with the incidence expected to rise into
the new millenium. Over the past 40 years,
MPM has been unequivocally linked to
asbestos exposure worldwide. Recently,
however, a new theory on the
carcinogenesis of this tumor has been
proposed with the isolation of a simian
virus (SV 40)-like gene sequence in
mesothelioma tumor cells. The clinical
presentation of MPM is variable, although
most patients typically present with
dyspnea, chest pain, or pleural effusion.
Obtaining a diagnosis of MPM has been
greatly assisted by video-assisted surgery
and the use of immunohistochemistry and
electron microscopic techniques, which
help distinguish MPM from other tumor
pathologies such as adenocarcinoma.
Computed tomography and magnetic resonance
imaging have been also useful for
determining tumor burden and
resectability. Traditionally, strategies
for the treatment of MPM have included
supportive care, surgery, radiotherapy,
and chemotherapy. Survival with supportive
care alone ranges between 4 and 12 months.
Single-modality therapy using traditional
approaches (surgery, radiotherapy,
chemotherapy) alone has failed to improve
patient survival significantly. Recently,
results using a multimodality approach
have been favorable. In particular,
cytoreductive surgery
(pleuropneumonectomy) followed by
sequential chemotherapy and radiotherapy
have demonstrated improved survival,
especially for patients with epithelial
histology, negative resection margins, and
no metastases to extrapleural lymph nodes.
Innovative therapies such as the use of
photodynamic, targeted cytokines and gene
therapy are currently being investigated
for management of MPM.
PMID:
11338024 [PubMed - in process]
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