bims-mesote Biomed News
on Mesothelioma
Issue of 2024–12–01
eight papers selected by
Laura Mannarino, Humanitas Research
  1. Paradoxical Improvement in Malignant Pleural Mesothelioma Outcomes Following Delayed Treatment Initiation.
  2. To Cut or Not to Cut: Peritoneal Dissemination After Pleurectomy/Decortication for Pleural Mesothelioma.
  3. Asbestos Burden in Lungs of Subjects Deceased From Mesothelioma Who Lived in Proximity to an Asbestos Factory: A Topographic Post-Mortem SEM-EDS Study.
  4. Reconstruction of diaphragm with cadaveric fascia lata during extended surgery for pleural mesothelioma: A single-center experience.
  5. Surgery for pleural mesothelioma in multimodality setting: comparison between surgical techniques in a high-volume center.
  6. Hyperthermic intrathoracic chemotherapy modulates the immune microenvironment of pleural mesothelioma and improves the impact of dual immune checkpoint inhibition.
  7. Cutaneous metastasis from pleural mesothelioma at site of radiation therapy: Case report and review of the literature.
  8. Malignant Pleural Effusion: Diagnosis and Treatment-Up-to-Date Perspective.
  1. Cancers (Basel). 2024 Nov 07. pii: 3755. [Epub ahead of print]16(22):
    Paradoxical Improvement in Malignant Pleural Mesothelioma Outcomes Following Delayed Treatment Initiation.
    Ashwin Kulshrestha, Emanuela Taioli, Andrea Wolf, Raja Flores, Stephanie Tuminello.
       BACKGROUND/OBJECTIVES: Time to treatment initiation (TTI) has been identified as a predictor of survival in many cancers, but its impact on malignant pleural mesothelioma (MPM) is unknown. This study investigates factors influencing TTI in MPM and its association with overall survival.
    METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was used to obtain data for MPM patients in the United States. TTI was defined as the number of days from diagnosis to initiation of first treatment, and delayed TTI was defined as exceeding the median TTI. Χ2 tests and t-tests compared sociodemographic and clinical differences between early and delayed TTI groups, while Kaplan-Meier and Cox proportional hazards models evaluated relationships between prognostic factors, TTI, and survival.
    RESULTS: Among 4879 MPM patients, the median TTI was 39 days. Median survival was 10 months among early TTI patients and 13 months among delayed TTI patients. Patients with epithelioid histology were more likely to have delayed TTI, as were patients who received combination therapy or were diagnosed more recently (p < 0.0001). Adjusting for covariates, delayed TTI status remained associated with better survival (HR 0.79, 95% CI: 0.74-0.84).
    CONCLUSIONS: This study presents an important insight into the management of MPM, demonstrating that delayed time to treatment initiation is positively associated with improved overall survival, contrary to findings in most cancers. This finding underscores the importance of comprehensive, multidisciplinary care, as delays due to robust staging evaluations and patient travel to high-volume centers of excellence likely contribute to delays in treatment. Taken together, these results suggest that clinicians should prioritize personalized treatment planning and collaborative care over a push to rapidly initiate treatment to optimize patient outcomes in MPM.
    Keywords:  disparities; malignant pleural mesothelioma (MPM); survival; thoracic surgery; time to treatment initiation (TTI)
    DOI:  https://doi.org/10.3390/cancers16223755
  2. Ann Surg Oncol. 2024 Nov 29.
    To Cut or Not to Cut: Peritoneal Dissemination After Pleurectomy/Decortication for Pleural Mesothelioma.
    Sadia Tasnim, Monisha Sudarshan.
      
    DOI:  https://doi.org/10.1245/s10434-024-16603-z
  3. Am J Ind Med. 2024 Nov 28.
    Asbestos Burden in Lungs of Subjects Deceased From Mesothelioma Who Lived in Proximity to an Asbestos Factory: A Topographic Post-Mortem SEM-EDS Study.
    Silvia Damiana Visonà, Matthew Untalan, Barbara Bertoglio, Silvana Capella, Elena Belluso, Marco Billò, Tara Ivic-Pavlicic, Emanuela Taioli.
       BACKGROUND: Asbestos exposure and its pathological consequences, especially malignant mesothelioma (MM) still represent a major public health problem on a global scale. After the ban of asbestos in most western countries, nonoccupational exposure plays an essential role in MM pathogenesis. However, few studies have quantified asbestos lung burden after environmental exposure. The main objective of this work is to understand if asbestos lung content is different between occupationally and environmentally exposed individuals, and if the distance between the subjects' residences and the source of exposure is significantly associated with the asbestos lung burden.
    METHODS: In this retrospective, observational study we quantified, with analytical scanning electron microscopy, asbestos content in lungs of individuals deceased from MM between 2005 and 2019, who were exposed to asbestos (occupationally and/or environmentally) in Broni, a small town in northern Italy where an important asbestos-cement plant operated until 1993.
    RESULTS: We analyzed asbestos lung content of 77 subjects. We found that the asbestos lung content in MM patients who lived around the asbestos factory was as high as that seen in occupationally exposed individuals; this holds true in residents up to 10 km radius from the factory. We found no significant associations between the residence duration/distance ratio and asbestos lung burden.
    CONCLUSIONS: This study suggests that heavy asbestos pollution involves not only the area adjacent to the factory, but the entire town of Broni and the surroundings. This is alarming if we consider that most asbestos factories still active in some countries are located close to towns and dwellings.
    Keywords:  asbestos; asbestos lung burden; environmental asbestos exposure; environmental epidemiology; scanning electron microscopy
    DOI:  https://doi.org/10.1002/ajim.23680
  4. Eur J Surg Oncol. 2024 Nov 16. pii: S0748-7983(24)01548-8. [Epub ahead of print]51(1): 109480
    Reconstruction of diaphragm with cadaveric fascia lata during extended surgery for pleural mesothelioma: A single-center experience.
    Eleonora Faccioli, Giovanni Zambello, Diletta Trojan, Gianluca Canu, Viola Sambataro, Chiara Giraudo, Marco Schiavon, Andrea Dell'Amore, Federico Rea.
       INTRODUCTION: Synthetic materials have traditionally been used to reconstruct the diaphragm during extensive surgery for pleural mesothelioma. However, new biomaterials have shown promising results in various surgical fields. This study describes our experience using homologous fascia lata for diaphragm reconstruction in patients undergoing surgery with radical intent for pleural mesothelioma.
    MATERIAL AND METHODS: Data from patients who underwent extensive surgery for pleural mesothelioma requiring diaphragm reconstruction from January 2021 to December 2023 were extracted and analyzed. Patients were divided in two groups based on the type of material used for diaphragm reconstruction: expanded polytetrafluoroethylene (ePTFE) and cadaveric homologous fascia lata.
    RESULTS: Forty-three consecutive patients were included in the analysis. Of these, 22 patients (51 %) underwent diaphragm reconstruction with expanded ePTFE prostheses, while 21 patients (49 %) had reconstruction using homologous fascia lata. No significant differences were found between the two groups in terms of in-hospital stay (14.5 vs 17 days, p = 0.865) and early post-operative complications (19 % vs 18 %, p = 0.943). Concerning long-term complications, a lower rate was found in the group treated with fascia lata (5 % vs 23 %, p = 0.09).
    CONCLUSIONS: Diaphragm reconstruction using cadaveric homologous fascia lata after extended surgery for pleural mesothelioma is feasible and results in satisfactory post-operative outcomes. Although the trend suggests fewer long-term complications with fascia lata, further research is needed to confirm these findings and determine the ideal prosthetic material for diaphragm reconstruction.
    Keywords:  Diaphragm reconstruction; Fascia lata; Pleural mesothelioma; Prostheses
    DOI:  https://doi.org/10.1016/j.ejso.2024.109480
  5. Eur J Cardiothorac Surg. 2024 Nov 28. pii: ezae431. [Epub ahead of print]
    Surgery for pleural mesothelioma in multimodality setting: comparison between surgical techniques in a high-volume center.
    Eleonora Faccioli, Andrea Dell'Amore, Giulia Lorenzoni, Marco Schiavon, Gianluca Canu, Giulia Pasello, Giovanni Zambello, Matteo Sepulcri, Viola Sambataro, Francesco Labella, Chiara Giraudo, Dario Gregori, Fiorella Calabrese, Federico Rea.
       OBJECTIVES: Pleural mesothelioma (PM) is an aggressive disease linked to asbestos exposure, presenting significant treatment challenges. The recommended approach is multimodal treatment, even if the concept of resectable PM and the superiority of one surgical technique over the other [(extended) pleurectomy decortication [(E)PD] vs extra-pleural pneumonectomy (EPP)] are matter of debates. The aim of this study is to compare the two techniques in terms of short- and long-term outcomes at a high-volume center.
    METHODS: Clinical data from PM patients who underwent radical surgery [(E)PD and EPP] between 1994 and 2022 were collected. A propensity score weighting approach was used for non-random intervention allocation. Survival distribution was estimated using Kaplan-Meier method and the association with outcomes was evaluated using a weighted Cox Proportional Hazard Models.
    RESULTS: Among 254 patients, 125 (49%) underwent EPP and 129 (51%) (E)PD. The 90-day mortality was higher in the EPP group (7.2% vs 0%; p = 0.01). No difference in 1-,3- and 5-year survival was found: 65.8%, 26%, 17% for EPP and 75.5%, 39.7% and 21.3% for (E)PD; p = 0.39). The multivariable weighted Cox model identified no increased risk of death (HR 1.25; p = 0.49) or recurrence (HR 1.05; p = 0.858) in the EPP group. Pre-operative total lung capacity (TLC) was significantly associated with a reduced risk of death (HR 0.96; p = 0.023) and recurrence (HR 0.97; p = 0.019) at follow-up while preoperative disease burden to a higher risk of recurrence (HR 1.01; p = 0.02).
    CONCLUSIONS: Our experience showed acceptable short- and long-term outcomes in both procedures, making EPP still an option only for carefully selected patients at high volume center. Surgery, although recently debated, should be performed exclusively in expert centers to minimize post-operative risks. The identification of new prognostic factors is crucial for better selecting patients who may benefit from surgery within the context of multimodal treatment.
    Keywords:  (extended) pleurectomy decortication; extra-pleural pneumonectomy; multimodality treatment; outcome; pleural mesothelioma; surgery
    DOI:  https://doi.org/10.1093/ejcts/ezae431
  6. Cancer Immunol Res. 2024 Nov 25.
    Hyperthermic intrathoracic chemotherapy modulates the immune microenvironment of pleural mesothelioma and improves the impact of dual immune checkpoint inhibition.
    Yameng Hao, Aspasia Gkasti, Amy J Managh, Julien Dagher, Alexandros Sifis, Luca Tiron, Louis-Emmanuel Chriqui, Damien N Marie, Olga De Souza Silva, Michel Christodoulou, Solange Peters, Johanna A Joyce, Thorsten Krueger, Michel Gonzalez, Etienne Abdelnour-Berchtold, Christine Sempoux, Daniel Clerc, Hugo Teixeira-Farinha, Martin Hübner, Etienne Meylan, Paul J Dyson, Sabrina Cavin, Jean Y Perentes.
      Pleural mesothelioma (PM) is a fatal disease with limited treatment options. Recently, PM management has improved with the development of immune checkpoint inhibitors (ICIs). In first-line therapy, dual PD-1 and CTLA-4 blockade enhances tumor control and patient survival compared with chemotherapy. Unfortunately, only a fraction of patients is responsive to immunotherapy, and approaches to reshape the tumor immune microenvironment and make ICIs more effective are urgently required. Here, we evaluated the effect of Hyperthermic IntraThOracic Chemotherapy (HITOC), a treatment that combines fever-range hyperthermia with local intrapleural cisplatin chemotherapy, on the tumor immune microenvironment and response to ICIs. To do this, we developed a murine PM model of HITOC. We found that HITOC significantly improved tumor control and animal survival through a mechanism involving the development of a cytotoxic immune response. Additionally, HITOC enhanced immune checkpoint expression by T lymphocytes and synergized with dual PD-1 and CTLA-4 inhibition, leading to further improvement in animal survival. Finally, the analysis of peritoneal mesothelioma patient samples treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) revealed a similar immunomodulation. In conclusion, HITOC remodels the tumor immune microenvironment of PM by promoting T-cell infiltration into the tumor and could be considered in combination with ICIs in the context of a clinical trial.
    DOI:  https://doi.org/10.1158/2326-6066.CIR-24-0245
  7. JAAD Case Rep. 2024 Dec;54 37-40
    Cutaneous metastasis from pleural mesothelioma at site of radiation therapy: Case report and review of the literature.
    William Abou Shahla, Dana Maria Khoury, Dana Saade.
      
    Keywords:  cutaneous metastasis; pleural mesothelioma; radiation therapy; skin disease
    DOI:  https://doi.org/10.1016/j.jdcr.2024.08.033
  8. Curr Oncol. 2024 Nov 02. 31(11): 6867-6878
    Malignant Pleural Effusion: Diagnosis and Treatment-Up-to-Date Perspective.
    Riccardo Orlandi, Andrea Cara, Enrico Mario Cassina, Sara Degiovanni, Lidia Libretti, Emanuele Pirondini, Federico Raveglia, Antonio Tuoro, Sara Vaquer, Stefania Rizzo, Francesco Petrella.
      Malignant pleural effusion is the presence of malignant cells within the pleural fluid, representing the second most common cause of pleural exudate. Although diagnostic methods and management techniques for malignant pleural effusion have dramatically improved over the decades, the current treatment is still palliative, aiming to remove pleural fluid, possibly prevent its recurrence, and alleviate symptoms through a wide range of available procedures. Treatment should be tailored to the individual patient, considering comorbidities, size of the effusion, rate of fluid accumulation, underlying cardiac or respiratory conditions, rate of recurrence, presence of loculations or trapped lung, tumor characteristics, cancer type, and patient preferences. This manuscript aims to review the available literature and to present the latest evidence on malignant pleural effusion management in order to provide an updated perspective on its diagnosis and treatment.
    Keywords:  indwelling pleural catheter; malignant pleural effusion; pleural biopsy; pleural fluid; talc poudrage; thoracoscopy
    DOI:  https://doi.org/10.3390/curroncol31110507
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