Although the initial report indicates that chemotherapeutic treatments can halt or eliminate mesothelioma, those with advanced mesothelioma have an extremely poor prognosis. If there is a possible cure, chemotherapy is by far not likely to change this, and chemotherapy will probably be associated with new and worsening symptoms due to the increased number of cancers affecting the brain. Our understanding of the biology and treatment of mesothelioma needs to be refined before further clinical trials can be contemplated.
Treatment often includes surgery, radiation, chemotherapy, or all three together. A combination of chemotherapy with either vincristine or cyclophosphamide may be used in patients in whom the disease was found to be resectable. The addition of radiation therapy may be used for treating palliative problems in the disease and to give a slight survival advantage. Patients are followed up for at least a year after surgery to monitor for symptom emergence (particularly weight loss) and further progression of the disease using imaging techniques. Chemotherapy should be administered at least three months after surgery and radiotherapy must take into account the cumulative dose of radiation given during a course of chemotherapy.
This report includes the first description of pleural malignant mesothelioma in a young patient. It was found that an early diagnosis and an adequate therapy can improve patients' quality of life, with limited effect to the survival rate. The case we presented might allow us to make a more accurate assessment and treatment of this tumors.
The Centers for Disease Control estimated 1244 new cases of mesothelioma will be diagnosed during 2009. There is a slight increase annually in new cases of mesothelioma from 1974, reflecting increased understanding of this disease and improved screening procedures. In the United States, about 40% to 90% of mesothelioma are caused by exposure to asbestos. Although the risk of mesothelioma in the U.S. worker has been declining, as of 2005, some 7,000 people in the U.S. were per year diagnosed with this deadly disease.
The cause of mesothelioma is still not well understood. Mesothelioma is thought to be linked to exposure to asbestos, and can develop for decades after the initial exposure. It also occurs without previous exposure to asbestos. Risk factors for developing mesothelioma have varied over the years with changes in occupational exposure to asbestos; cigarette smoking; and in recent years, the use of multiple types of certain types of clothing and shoes. Mesothelioma will also occur in people who have been exposed to asbestos in the workplace. It is possible for one person to develop this cancer and another person to develop the same cancer and not have had anything to do with asbestos.
The key diagnostic sign of mesothelioma is a history of asbestos exposure. This should always alert the clinician to the possibility of malignant mesothelioma, which occurs very rarely otherwise. The combination of pain (particularly in upper pleural sites) and pleuritic chest symptoms (particularly in left-lateral settings) with imaging findings of mesothelioma are the most reliable signs of malignant mesothelioma.
• We found that there is a high rate of pre-operative chemotherapy failure when used in patients who present for surgical resection. • We also showed that higher grade tumors with diffuse disease were more likely to fail pre-operative chemotherapy in this setting.
We conclude that in this study there was no difference in survival between patients who underwent pre-op chemotherapy as either adjuvant or neoadjuvant treatments and those who underwent preoperative chemotherapy with radical resections for stage IIIC and IV disease. Survival was significantly longer in patients who received 4 cycles as adjuvant treatment. Survival should not be a deciding factor when evaluating candidates for surgical treatment vs preoperative chemotherapy in this stage of disease. Further studies are needed with longer follow-up to validate these results.
The study showed that rt +/- chemotherapy was one of the most common treatments used in combination with other treatments. We found that chemotherapy was used with curative intent in more than 40% of the cases. We observed that the use of rt +/- chemotherapy had a substantial effect on survival and quality of life of the patients. In addition, we found that patients who underwent combined modality therapy (rt +/- chemotherapy) had better survival compared with other groups of patients who underwent surgery only or RT only (RT only had the highest rate of locoregional failure).
Mesothelioma patient survival curves for all races appear to be in the 90-95% range. This indicates that other factors and/or therapies are contributing to this survival statistic. Although these survival curves are the most current, all three major cancers in the U.S., are all considered incurable. Therefore, to achieve survival that is on par with other American cancers, we must continue efforts to improve patient survival.
Pre-operative chemotherapy in the treatment of mesothelioma is only feasible in rare tumors. It may delay adjuvant radiotherapy. It alters survival by 7 days in non-diseased patients and it is not available. However, pre-operative chemotherapy may be used to increase survival when radiotherapy is indicated.
We are still in the early stages of drug development for mesothelioma treatment. Research and clinical trials remain necessary to help guide clinical practice, assess efficacy and risk, and identify additional treatment options.