Bilateral thoracoscopy, mediastinoscopy and laparoscopy, in addition to CT, MRI and PET imaging, are essential to correctly stage and treat patients with mesothelioma prior to trimodality therapy.

Abstract:

BACKGROUND:Trimodality therapy (TMT; extrapleural pneumonectomy (EPP), chemotherapy and radiation therapy) offers the potential of optimal survival in selected patients with Brigham stage I-II epitheliod mesothelioma based on CT, MRI and PET scanning. We hypothesized that these scanning modalities were inadequate to accurately stage these patients. METHODS:Patients suitable for TMT, in addition to CT, MRI and PET scanning, prior to EPP, underwent bilateral thoracoscopy, mediastinoscopy and laparoscopy (surgical staging). Follow-up CT scans were performed, six monthly, quality of life assessments yearly. RESULTS:From 1 June 2004 to 28 February 2007, 34 patients were referred; mean age was 66 years (range: 44-69). Surgical staging was performed in 30 patients; 24 patients were confirmed as Brigham Stage I-II. However, six were upstaged, five as stage IV disease (one contralateral chest, two contralateral chest and abdomen, two abdomen) and one as mediastinal node positive; two further patients were reclassified histologically (one sarcomatoid, one biphasic). These eight patients fared poorly, 50% dying within 1 year from mesothelioma. Following surgical staging, 3 patients declined further surgery; thus, 19 patients proceeded to surgery, 3 were unresectable and 16 received EPP. Follow-up of all 34 patients is complete. CONCLUSION:Surgical staging identified 26% of patients who would have received no benefit from TMT.

journal_name

ANZ J Surg

journal_title

ANZ journal of surgery

authors

Alvarez JM,Hasani A,Segal A,Sterret G,Millward M,Nowak A,Musk W,Bydder S

doi

10.1111/j.1445-2197.2009.05060.x

subject

Has Abstract

pub_date

2009-10-01 00:00:00

pages

734-8

issue

10

eissn

1445-1433

issn

1445-2197

pii

ANS5060

journal_volume

79

pub_type

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