All about Mesothelioma: Mesothelioma Survival Rates
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Mesothelioma — a rare malignancy that develops in the mesothelium of the pleura or peritoneum. The mesothelioma survival rates can be a source of the pleura (pleural mesothelioma), abdomen (peritoneal mesothelioma), a pericardium (pericardial mesothelioma) as well as the tunica vaginal testis (testicular mesothelioma). Currently, we conducted additional research on elucidating the role of SV40 in causing mesothelioma. Other etiological factors contributing to the development of mesothelioma include exposure to ionizing radiation in history, as well as rare familial forms.
Mesothelioma, clinical manifestations: mesothelioma survival rates
The most common clinical manifestations of pleural mesothelioma survival rates are shortness of breath on exertion and shortness of breath. Most physicians in the identification of the symptoms prescribe chest radiography in this case reveals a unilateral pleural effusion. In rare cases, mesothelioma is a random finding on routine chest X-ray. Patients also may complain of chest pain that is not related to breathing. This symptom has significant diagnostic value as it allows identifying patients with inoperable tumors (in these cases, the pain caused by tumor invasion in the chest). Also, can be observed: the asymmetry of the respiratory movements, weight loss, sweating at night and having the volume of subcutaneous education.
Mesothelioma survival rates — What is the complexity of the diagnosis?
When first discovered pleural effusion thoracentesis performed to establish the nature of the effusion. Often, when mesothelioma survival rates observed negative cytology, in such cases for the diagnosis of mesothelioma often to repeat the puncture. Because of the frequent negative cytology results cannot be considered a reliable method of diagnosis of mesothelioma. Furthermore, cytology is often not possible to establish a histological variant of mesothelioma, it is important for prognosis.
The best method for diagnosing mesothelioma survival rates thoracoscopic biopsy. This method has many advantages. Firstly, it enables the surgeon to assess the depth of tumor invasion into the visceral and parietal pleura. Secondly, a biopsy is performed under direct vision, which is essential for the correct histological diagnosis. Finally, when thoracoscopy pleurodesis can be performed to help prevent re-effusion. It should be noted that the centers of mesothelioma can occur at the site of an earlier biopsy.
For the examination of patients with newly diagnosed mesothelioma survival rates used computed tomography (CT), positron emission tomography (PET) and magnetic resonance imaging (MRI). CT with contrast circular lobed often reveals pleural moorings combined with pleural effusion or without. With CT can reveal pleural plaques, indicating prior contact with asbestos, as well as the spread of the tumor in the interlobar pleura. However, CT is not always possible to accurately determine whether the tumor grows into the chest wall or diaphragm. Evaluation of these parameters is very important, especially if you plan surgical treatment of mesothelioma. In such situations, it is advisable to use MRI, which enables to evaluate germination in the chest wall and the diaphragm. Because most mesothelioma PET-positive, most recently for the diagnosis of these tumors more commonly used PET with fluorodeoxyglucose. As with lung cancer, the method allows the study to identify micrometastases in patients who scheduled surgery. However, further studies are needed to determine the diagnostic value of PET with fluorodeoxyglucose for localized and locally advanced forms of mesothelioma.
Mesothelioma and Staging: mesothelioma survival rates
The literature describes many classifications for staging pleural mesothelioma, whereas for peritoneal mesothelioma such classification has not been developed. The main purpose of the determination of the stage of pleural mesothelioma — prognosis, as well as the identification of patients with possible surgical treatment. The most widely used classification of the International Group for the Study of mesothelioma (the International Mesothelioma Interest Group — IMIG), is a modification of the classification of TNM. Just to set the stage of mesothelioma, based on the results of radiation diagnosis is difficult, often it can be done only during the operation.
Prognostic factors of mesothelioma: mesothelioma survival rates
To date, there is no radical treatment of mesothelioma. The median survival of patients with the newly diagnosed disease is 6 to 18 months. Mesothelioma (even in the absence of treatment) may occur differently, so developed several systems for evaluating the forecast, allowing highlight subgroups of patients with different prognosis. The most widely used system of evaluation of the forecast developed by the Study Group for Research on Cancer and leukemia, as well as the European Organization for Research and Treatment of cancer. The group with a poor prognosis are patients with sarcomatoid mesothelioma type, with the severe general condition, as well as patients with chest pain (indicating that the germination of the tumor in the chest wall). Furthermore, the presence of poor prognosis of the systemic inflammatory response syndrome for mesothelioma, which is manifested by leukocytosis and thrombocytosis.
To date, there are no uniform standards for the treatment of mesothelioma. One of the reasons — lack of randomized clinical trials that compare different treatments. A variety of approaches to the treatment of mesothelioma — from palliative care and chemotherapy prior to major surgery, the choice of an approach depends on the patient’s age, comorbidities, and general condition.
The real effectiveness of certain treatments for mesothelioma is not defined. This is due to factors such as rare diseases, insufficient number of randomized trials, the lack of a unified approach to the definition of the stage, the differences between the histological types of mesothelioma, nonequivalence of prognostic factors, as well as the difficulty of evaluating the effectiveness of treatment with RT and other methods of radiation diagnosis. At present, it is not clear whether the increased any method of treating mesothelioma survival compared to using only palliative therapy. Mesothelioma occurs differently, so the benefits identified in clinical trials may be due to the selection of patients. Many patients need to control the volume of pleural effusion and no need to immediately apply the systemic or topical treatment. Currently, a number of ongoing clinical trials studying the efficacy of the treatment in comparison with palliative therapy.
Chemotherapy mesothelioma survival rates
That mesothelioma is resistant to systemic chemotherapy in clinical trials for the treatment of mesothelioma has tried most of the drugs used. The most effective as a monotherapy showed antifolates platinum derivatives (cisplatin and carboplatin), vinorelbine, and gemcitabine. The drug is administered intravenously, not only, but also in the pleural or peritoneal cavity. In phase III clinical trial comparing the efficacy of the combination of cisplatin and pemetrexed monotherapy cisplatin as initial treatment of patients with mesothelioma. It was shown that the response rate (41%) and median survival (12 mo.) Above the group of patients treated with combination chemotherapy as compared to those who received mono-chemotherapy (16.7 and 9.3% respectively). Based on the results of the study, the combination of cisplatin and pemetrexed was officially approved by the FDA for the treatment of mesothelioma and is included in the standard treatment of this disease.
Also studied and demonstrated the efficacy of alternative chemotherapeutic agents, particularly folate, antimetabolites (gemcitabine, cisplatin / gemcitabine), and platinum derivatives (carboplatin; carboplatin / pemetrexed). Today, ongoing research on the effectiveness of second-line chemotherapy for mesothelioma.
In addition to chemotherapy, we investigated the use of targeted therapies with mesothelioma. According to preliminary results or inhibitors of the epidermal growth factor receptor (gefitinib and erlotinib), inhibitors or platelet-derived growth factor receptor (imatinib) have no activity against mesothelioma. Since mesothelioma angiogenesis characterized by high activity, high-efficiency monotherapy showed angiogenesis inhibitors such as SU5416, thalidomide, and PTK787. Finally, to date completed a large Phase II randomized clinical trial, dedicated to the study of bevacizumab (a monoclonal antibody to vascular endothelial growth factor); Results of this study have not been published.
Radiation therapy: mesothelioma survival rates
Most patients with mesothelioma chemotherapy are ineffective. Radiation therapy is often used for palliation, as well as to reduce the likelihood of tumor invasion into the area where performed surgery or biopsy was performed. Moreover, irradiation of the affected part of the chest after the PES is used. Since in many cases, after the PES on the edge of resection (or very close to it) detecting tumor cells, radiation therapy can reduce the incidence of local recurrence. In patients with early stages of mesothelioma, which was conducted irradiation of the affected part of the chest, lower the risk of recurrence in the area of operations, but significantly higher risk of getting distant metastases. In treating most patients use a combination of surgery, chemotherapy, and radiotherapy.