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May IJ, Nowak AK, Francis RJ, Ebert MA, Dhaliwal SS. The prognostic value of F18 Fluorothymidine positron emission tomography for assessing the response of malignant pleural mesothelioma to chemotherapy - A prospective cohort study. J Med Imaging Radiat Oncol 2024; 68:57-66. [PMID: 37898984 DOI: 10.1111/1754-9485.13592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 09/21/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Malignant pleural mesothelioma is difficult to prognosticate. F18-Fluorodeoxyglucose positron emission tomography (FDG PET) shows promise for response assessment but is confounded by talc pleurodesis. F18-Fluorothymidine (FLT) PET is an alternative tracer specific for proliferation. We compared the prognostic value of FDG and FLT PET and determined the influence of talc pleurodesis on these parameters. METHODS Overall, 29 prospectively recruited patients had FLT PET, FDG PET and CT-scans performed prior to and post one chemotherapy cycle; 10 had prior talc pleurodesis. Patients were followed for overall survival. CT response was assessed using mRECIST. Radiomic features were extracted using the MiM software platform. Changes in maximum SUV (SUVmax), mean SUV (SUVmean), FDG total lesion glycolysis (TLG), FLT total lesion proliferation (TLP) and metabolic tumour volume (MTV) after one chemotherapy cycle. RESULTS Cox univariate analysis demonstrated FDG PET radiomics were confounded by talc pleurodesis, and that percentage change in FLT MTV was predictive of overall survival. Cox multivariate analysis showed a 10% increase in FLT tumour volume corresponded with 9.5% worsened odds for overall survival (P = 0.028, HR = 1.095, 95% CI [1.010, 1.187]). No other variables were significant on multivariate analysis. CONCLUSION This is the first prospective study showing the statistical significance of FLT PET tumour volumes for measuring mesothelioma treatment response. FLT may be better than FDG for monitoring mesothelioma treatment response, which could help optimise mesothelioma treatment regimes.
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Affiliation(s)
- Isaac J May
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Anna K Nowak
- Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- National Centre for Asbestos Related Diseases (NCARD), Nedlands, Western Australia, Australia
| | - Roslyn J Francis
- Department Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Faculty of Medicine, School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Martin A Ebert
- Radiation Oncology Cancer, Imaging & Clinical Services, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Department of Physics, School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, Western Australia, Australia
| | - Satvinder S Dhaliwal
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, B305, Curtin University, Bentley, Western Australia, Australia
- Duke-NUS Medical School, National University of Singapore, Singapore City, Singapore
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Penang, Pulau Pinang, Malaysia
- Singapore University of Social Sciences, Singapore City, Singapore
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2
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Menon AR, Cheema A, Hou S, Attwood KM, White T, James G, Xu B, Petroziello M, Roche CL, Kurenov S, Kauffman EC. Stability of renal parenchymal volume and function during active surveillance of renal oncocytoma patients. Urol Oncol 2023; 41:208.e15-208.e23. [PMID: 36842877 PMCID: PMC10959122 DOI: 10.1016/j.urolonc.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/28/2022] [Accepted: 01/09/2023] [Indexed: 02/28/2023]
Abstract
INTRODUCTION AND OBJECTIVE To evaluate whether significant loss in ipsilateral renal parenchymal volume (IRPV) and renal function occurs during active surveillance (AS) of renal oncocytoma (RO) patients. METHODS Renal function (estimated glomerular filtration rate, eGFR) dynamics were retrospectively analyzed in 32 consecutive biopsy-diagnosed RO patients managed with AS at a National Comprehensive Cancer Network institute. Three-dimensional kidney and tumor reconstructions were generated and IRPV was calculated using volumetry software (Myrian®) for all patients with manually estimated RO growth >+10 cm3. GFR and IRPV were compared at AS initiation vs. the last follow-up using 2-sided paired t-tests. The correlation between change in IRPV and change in RO size or GFR was tested using a Spearman coefficient. RESULTS With median follow-up of 37 months, there was no significant change between initial vs. last eGFR (median 71.0 vs. 70.5 ml/min/1.73 m2, P = 0.50; median change -3.0 ml/min/1.73 m2). Among patients (n = 17) with RO growth >+10 cm3 during AS (median growth +28.6 cm3, IQR +16.9- + 46.5 cm3), IRPV generally remained stable (median change +0.5%, IQR -1.2%- + 1.2%), with only 2 cases surpassing 5% loss. No IRPV loss was detected among any patient within the top tertile of RO growth magnitude. RO growth magnitude did not correlate with loss of either IRPV (ρ = -0.30, P = 0.24) or eGFR (ρ = -0.16, P = 0.40), including among patient subsets with lower initial eGFR. Study limitations include a lack of long-term follow-up. CONCLUSIONS Volumetry is a promising novel tool to measure kidney and tumor tissue changes during AS. Our study using volumetry indicates that clinically significant loss of IRPV or eGFR is uncommon and unrelated to tumor growth among untreated RO patients with intermediate follow-up. These findings support that AS is in general functionally safe for RO patients, however longer study is needed to determine safety durability, particularly among uncommon ≥cT2 RO variants.
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Affiliation(s)
- Arun R Menon
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Amandip Cheema
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Surui Hou
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Kristopher M Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Tashionna White
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Gaybrielle James
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Bo Xu
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Michael Petroziello
- Department of Radiology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Charles L Roche
- Department of Radiology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Sergei Kurenov
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Eric C Kauffman
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Department of Cancer Genetics, Roswell Park Comprehensive Cancer Center, Buffalo, NY.
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Katz SI, Straus CM, Roshkovan L, Blyth KG, Frauenfelder T, Gill RR, Lalezari F, Erasmus J, Nowak AK, Gerbaudo VH, Francis RJ, Armato SG. Considerations for Imaging of Malignant Pleural Mesothelioma: A Consensus Statement from the International Mesothelioma Interest Group. J Thorac Oncol 2023; 18:278-298. [PMID: 36549385 DOI: 10.1016/j.jtho.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/13/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022]
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive primary malignancy of the pleura that presents unique radiologic challenges with regard to accurate and reproducible assessment of disease extent at staging and follow-up imaging. By optimizing and harmonizing technical approaches to imaging MPM, the best quality imaging can be achieved for individual patient care, clinical trials, and imaging research. This consensus statement represents agreement on harmonized, standard practices for routine multimodality imaging of MPM, including radiography, computed tomography, 18F-2-deoxy-D-glucose positron emission tomography, and magnetic resonance imaging, by an international panel of experts in the field of pleural imaging assembled by the International Mesothelioma Interest Group. In addition, modality-specific technical considerations and future directions are discussed. A bulleted summary of all technical recommendations is provided.
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Affiliation(s)
- Sharyn I Katz
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Christopher M Straus
- Department of Radiology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Leonid Roshkovan
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kevin G Blyth
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Thomas Frauenfelder
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Ritu R Gill
- Department of Radiology, Beth Israel Lahey Health, Harvard Medical School, Boston, Massachusetts
| | - Ferry Lalezari
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeremy Erasmus
- Department of Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Anna K Nowak
- Medical School, University of Western Australia, Perth, Australia
| | - Victor H Gerbaudo
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Roslyn J Francis
- Medical School, University of Western Australia, Perth, Australia; Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Samuel G Armato
- Department of Radiology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
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4
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Kidd AC, Anderson O, Cowell GW, Weir AJ, Voisey JP, Evison M, Tsim S, Goatman KA, Blyth KG. Fully automated volumetric measurement of malignant pleural mesothelioma by deep learning AI: validation and comparison with modified RECIST response criteria. Thorax 2022; 77:1251-1259. [PMID: 35110367 PMCID: PMC9685726 DOI: 10.1136/thoraxjnl-2021-217808] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/20/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND In malignant pleural mesothelioma (MPM), complex tumour morphology results in inconsistent radiological response assessment. Promising volumetric methods require automation to be practical. We developed a fully automated Convolutional Neural Network (CNN) for this purpose, performed blinded validation and compared CNN and human response classification and survival prediction in patients treated with chemotherapy. METHODS In a multicentre retrospective cohort study; 183 CT datasets were split into training and internal validation (123 datasets (80 fully annotated); 108 patients; 1 centre) and external validation (60 datasets (all fully annotated); 30 patients; 3 centres). Detailed manual annotations were used to train the CNN, which used two-dimensional U-Net architecture. CNN performance was evaluated using correlation, Bland-Altman and Dice agreement. Volumetric response/progression were defined as ≤30%/≥20% change and compared with modified Response Evaluation Criteria In Solid Tumours (mRECIST) by Cohen's kappa. Survival was assessed using Kaplan-Meier methodology. RESULTS Human and artificial intelligence (AI) volumes were strongly correlated (validation set r=0.851, p<0.0001). Agreement was strong (validation set mean bias +31 cm3 (p=0.182), 95% limits 345 to +407 cm3). Infrequent AI segmentation errors (4/60 validation cases) were associated with fissural tumour, contralateral pleural thickening and adjacent atelectasis. Human and AI volumetric responses agreed in 20/30 (67%) validation cases κ=0.439 (0.178 to 0.700). AI and mRECIST agreed in 16/30 (55%) validation cases κ=0.284 (0.026 to 0.543). Higher baseline tumour volume was associated with shorter survival. CONCLUSION We have developed and validated the first fully automated CNN for volumetric MPM segmentation. CNN performance may be further improved by enriching future training sets with morphologically challenging features. Volumetric response thresholds require further calibration in future studies.
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Affiliation(s)
- Andrew C Kidd
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Owen Anderson
- School of Computing Science, University of Glasgow, Glasgow, UK
- Canon Medical Research Europe Ltd, Edinburgh, UK
| | - Gordon W Cowell
- Department of Imaging, Queen Elizabeth University Hospital, Glasgow, UK
| | | | | | - Matthew Evison
- Department of Respiratory Medicine, University Hospital of South Manchester, Manchester, UK
| | - Selina Tsim
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | - Kevin G Blyth
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Beatson Institute for Cancer Research, Glasgow, UK
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Martini K, Frauenfelder T. Old Borders and New Horizons in Multimodality Imaging of Malignant Pleural Mesothelioma. Thorac Cardiovasc Surg 2022; 70:677-683. [PMID: 34062600 DOI: 10.1055/s-0041-1728714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The purpose of this article is to describe the various imaging techniques involved in detection, staging, and preoperative planning in malignant pleural mesothelioma (MPM) focusing on new imaging modalities. METHODS For this purpose, first a brief summary of the etiology of MPM is given. Second, not only the commonly known, but also novel imaging modalities used in MPM will be discussed. RESULTS A wide range of imaging methods, from conventional chest radiography, through computed tomography and hybrid imaging to radiomics and artificial intelligence, can be used to evaluate MPM. CONCLUSION Nowadays multimodality imaging is considered the cornerstone in MPM diagnosis and staging.
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Affiliation(s)
- Katharina Martini
- University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich, ZH, Switzerland.,University of Zurich, Faculty of Medicine Zurich, ZH, Switzerland
| | - Thomas Frauenfelder
- University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich, ZH, Switzerland.,University of Zurich, Faculty of Medicine Zurich, ZH, Switzerland
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Greb D, Hebeisen M, Matter A, Opitz I, Lauk O. Prospective validation and extension of the Multimodality Prognostic Score for the treatment allocation of pleural mesothelioma patients. Eur J Cardiothorac Surg 2022; 62:6546747. [PMID: 35274127 PMCID: PMC9334788 DOI: 10.1093/ejcts/ezac085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Daria Greb
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Monika Hebeisen
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alessandra Matter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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Pilot Study to Evaluate Serum Soluble Mesothelin-Related Peptide (SMRP) as Marker for Clinical Monitoring of Pleural Mesothelioma (PM): Correlation with Modified RECIST Score. Diagnostics (Basel) 2021; 11:diagnostics11112015. [PMID: 34829362 PMCID: PMC8623660 DOI: 10.3390/diagnostics11112015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Accepted: 10/28/2021] [Indexed: 12/18/2022] Open
Abstract
A soluble mesothelin-related peptide (SMRP) is the only FDA-approved biomarker for diagnosis of pleural mesothelioma (PM) and the most used for monitoring treatment. Radiological assessment of PM, based on modified RECIST (mRECIST) criteria, is challenging. This pilot study was designed to evaluate whether SMRP levels correlated over time with mRECIST score. Serial serum samples from PM patients were collected and SMRP levels were measured and compared with the mRECIST score obtained through centralized CT scans by blinded review. The within-patient SMRP-mRECIST relationship over time was estimated through a normal random-effects regression approach applied to the log-transformed mRECIST score. Overall, 58 PM patients were included (46 males and 12 females) with a median age at diagnosis of 67 years (min–max = 48–79), 44 (76%) with epithelioid and 14 (24%) with non-epithelioid histology. The total number of SMRP measurements and CT scans considered for analysis was 183. There was a statistically significant correlation between SMRP and mRECIST score in the 2 cohorts considered both separately and jointly. These results, although exploratory, suggest that SMRP measurement might be considered as an adjunct to monitor PM patients in order to delay CT scans time interval, thus warranting further investigation.
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Romei C, Fanni SC, Volpi F, Milazzo A, D’Amore CA, Colligiani L, Neri E, De Liperi A, Stella GM, Bortolotto C. New Updates of the Imaging Role in Diagnosis, Staging, and Response Treatment of Malignant Pleural Mesothelioma. Cancers (Basel) 2021; 13:cancers13174377. [PMID: 34503186 PMCID: PMC8430786 DOI: 10.3390/cancers13174377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
Malignant pleural mesothelioma is a rare neoplasm with poor prognosis. CT is the first imaging technique used for diagnosis, staging, and assessment of therapy response. Although, CT has intrinsic limitations due to low soft tissue contrast and the current staging system as well as criteria for evaluating response, it does not consider the complex growth pattern of this tumor. Computer-based methods have proven their potentiality in diagnosis, staging, prognosis, and assessment of therapy response; moreover, computer-based methods can make feasible tasks like segmentation that would otherwise be impracticable. MRI, thanks to its high soft tissue contrast evaluation of contrast enhancement and through diffusion-weighted-images, could replace CT in many clinical settings.
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Affiliation(s)
- Chiara Romei
- 2nd Radiology Unit, Radiology Department, Pisa University Hospital, 56124 Pisa, Italy;
- Correspondence: (C.R.); (S.C.F.)
| | - Salvatore Claudio Fanni
- Department of Translational Research, Academic Radiology, University of Pisa, 56124 Pisa, Italy; (F.V.); (A.M.); (C.A.D.); (L.C.); (E.N.)
- Correspondence: (C.R.); (S.C.F.)
| | - Federica Volpi
- Department of Translational Research, Academic Radiology, University of Pisa, 56124 Pisa, Italy; (F.V.); (A.M.); (C.A.D.); (L.C.); (E.N.)
| | - Alessio Milazzo
- Department of Translational Research, Academic Radiology, University of Pisa, 56124 Pisa, Italy; (F.V.); (A.M.); (C.A.D.); (L.C.); (E.N.)
| | - Caterina Aida D’Amore
- Department of Translational Research, Academic Radiology, University of Pisa, 56124 Pisa, Italy; (F.V.); (A.M.); (C.A.D.); (L.C.); (E.N.)
| | - Leonardo Colligiani
- Department of Translational Research, Academic Radiology, University of Pisa, 56124 Pisa, Italy; (F.V.); (A.M.); (C.A.D.); (L.C.); (E.N.)
| | - Emanuele Neri
- Department of Translational Research, Academic Radiology, University of Pisa, 56124 Pisa, Italy; (F.V.); (A.M.); (C.A.D.); (L.C.); (E.N.)
| | - Annalisa De Liperi
- 2nd Radiology Unit, Radiology Department, Pisa University Hospital, 56124 Pisa, Italy;
| | - Giulia Maria Stella
- Unit of Respiratory Diseases, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation, University of Pavia Medical School, 27100 Pavia, Italy;
| | - Chandra Bortolotto
- Unit of Radiology, Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia Medical School, 27100 Pavia, Italy;
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Abstract
PURPOSE OF REVIEW Malignant pleural mesothelioma (MPM) is a rare, but aggressive tumor with still poor prognosis. In this article, we focus on recent developments in the management of MPM including diagnosis, staging, biomarkers, and treatment strategies. RECENT FINDINGS Molecular markers such as programmed death-ligand 1 (PDL-1), Breast Cancer gene 1-associated protein gene, and cyclin-dependent kinase inhibitor 2A (CDKN2A) have prognostic impact and should be considered for assessment in patient samples. In addition to histological subtype and tumor pattern, tumor volumetry plays an increasing important role in staging, assessment of treatment response, and prediction of survival. Several new blood-based biomarkers have been recently reported including peripheral blood DNA methylation, microRNAs, fibulin, and high-mobility group box 1, but have not been established in clinical routine use yet. Regarding treatment, targeted therapies, immunotherapy, and vaccination are considered as new promising strategies. Moreover, extended pleurectomy/decortication is favored over extrapleural pneumonectomy (EPP) and intensity-modulated radiotherapy represents a possible approach in combination with EPP and pleurectomy/decortication. Intracavitary treatment options are promising and deserve further investigations. SUMMARY Overall, there has not been a real breakthrough in the treatment of MPM. Further research and clinical trials are needed to evaluate outcome and to identify new potential treatment candidates.
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Lauk O, Patella M, Neuer T, Battilana B, Frauenfelder T, Nguyen-Kim TDL, Weder W, Caviezel C, Hillinger S, Inci I, Opitz I. Implementing CT tumor volume and CT pleural thickness into future staging systems for malignant pleural mesothelioma. Cancer Imaging 2021; 21:48. [PMID: 34344472 PMCID: PMC8330125 DOI: 10.1186/s40644-021-00415-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives Tumor thickness and tumor volume measured by computed tomography (CT) were suggested as valuable prognosticator for patients’ survival diagnosed with malignant pleural mesothelioma (MPM). The purpose was to assess the accuracy of CT scan based preoperatively measured tumor volume and thickness compared to actual tumor weight of resected MPM specimen and pathologically assessed tumor thickness, as well as an analysis of their impact on overall survival (OS). Methods Between 09/2013–08/2018, 74 patients were treated with induction chemotherapy followed by (extended) pleurectomy/decortication ((E)PD). In 53 patients, correlations were made between CT-measured volume and -tumor thickness (cTV and cTT) and actual tumor weight (pTW) based on the available values. Further cTV and pT/IMIG stage were correlated using Pearson correlation. Overall survival (OS) was calculated with Kaplan Meier analysis and tested with log rank test. For correlation with OS Kaplan-Meier curves were made and log rank test was performed for all measurements dichotomized at the median. Results Median pathological tumor volume (pTV) and pTW were 530 ml [130 ml – 1000 ml] and 485 mg [95 g – 982 g] respectively. Median (IQR) cTV was 77.2 ml (35.0–238.0), median cTT was 9.0 mm (6.2–13.7). Significant association was found between cTV and pTV (R = 0.47, p < 0.001) and between cTT and IMIG stage (p = 0,001) at univariate analysis. Multivariate regression analysis revealed, that only cTV correlates with pTV. Median follow-up time was 36.3 months with 30 patients dead at the time of the analysis. Median OS was 23.7 months. 1-year and 3-year survival were 90 and 26% respectively and only the cTV remained statistically associated with OS. Conclusion Preoperatively assessed CT tumor volume and actual tumor volume showed a significant correlation. CT tumor volume may predict pathological tumor volume as a reflection of tumor burden, which supports the integration of CT tumor volume into future staging systems.
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Affiliation(s)
- Olivia Lauk
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Miriam Patella
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Neuer
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Bianca Battilana
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thi Dan Linh Nguyen-Kim
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Claudio Caviezel
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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Opitz I, Furrer K. Preoperative Identification of Benefit from Surgery for Malignant Pleural Mesothelioma. Thorac Surg Clin 2021; 30:435-449. [PMID: 33012431 DOI: 10.1016/j.thorsurg.2020.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the absence of standardized treatment algorithms for patients with malignant pleural mesothelioma, one of the main difficulties remains patient allocation to therapies with potential benefit. This article discusses clinical, radiologic, pathologic, and molecular prognostic factors as well as genetic background leading to preoperative identification of benefit from surgery, which have been investigated over the past years to simplify and at the same time specify patient selection for surgical treatment.
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Affiliation(s)
- Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
| | - Katarzyna Furrer
- Department of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
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12
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Tsim S, Cowell GW, Kidd A, Woodward R, Alexander L, Kelly C, Foster JE, Blyth KG. A comparison between MRI and CT in the assessment of primary tumour volume in mesothelioma. Lung Cancer 2020; 150:12-20. [PMID: 33039775 DOI: 10.1016/j.lungcan.2020.09.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Primary tumour staging in Malignant Pleural Mesothelioma (MPM) using Computed Tomography (CT) imaging is confounded by perception errors reflecting low spatial resolution between tumour and adjacent structures. Augmentation using perfusion CT is constrained by radiation dosage. In this study, we evaluated an alternative tumour staging method using perfusion-tuned Magnetic Resonance Imaging (MRI). METHODS Consecutive patients with suspected MPM were recruited to a prospective observational study. All had MRI (T1-weighted, isotropic, contrast-enhanced 3-Tesla perfusion imaging) and CT (contrast-enhanced) pre-biopsy. Patients diagnosed with MPM underwent MRI and CT volumetry, with readers blinded to clinical data. MRI volumetry was semi-automated, using signal intensity limits from perfusion studies to grow tumour regions within a pleural volume. A similar CT method was not possible, therefore all visible tumour was manually segmented. MRI and CT volumes were compared (agreement, correlation, analysis time, reproducibility) and associations with survival examined using Cox regression. RESULTS 58 patients were recruited and had MRI before biopsy. 31/58 were diagnosed with MPM and these scans were used for volumetry. Mean (SD) MRI and CT volumes were 370 cm3 and 302 cm3, respectively. MRI volumes were larger (average bias 61.9 cm3 (SD 116), 95 % limits (-165.5 - 289 cm3), moderately correlated with CT (r = 0.56, p = 0.002) and independently associated with survival (HR 4.03 (95 % CI 1.5-11.55), p = 0.006). CT volumes were not associated with survival, took longer to compute than MRI volumes (mean (SD) 151 (19) v 14 (2) minutes, p=<0.0001) and were less reproducible (inter-observer ICC 0.72 for CT, 0.96 for MRI). CONCLUSIONS MRI and CT generate different tumour volumes in MPM. In this study, MRI volumes were larger and were independently associated with survival. MRI volumetry was quicker and more reproducible than CT.
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Affiliation(s)
- Selina Tsim
- Glasgow Pleural Disease Unit, Queen ElIzabeth University Hospital, Glasgow, United Kingdom
| | - Gordon W Cowell
- Imaging Department, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Andrew Kidd
- Glasgow Pleural Disease Unit, Queen ElIzabeth University Hospital, Glasgow, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Rosemary Woodward
- Clinical Research Imaging Facility, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Laura Alexander
- Cancer Research UK Clinical Trials Unit Glasgow, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Caroline Kelly
- Cancer Research UK Clinical Trials Unit Glasgow, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - John E Foster
- Clinical Research Imaging Facility, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Kevin G Blyth
- Glasgow Pleural Disease Unit, Queen ElIzabeth University Hospital, Glasgow, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom.
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13
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Three-dimensional versus two-dimensional video-assisted hepatectomy for liver disease: a meta-analysis of clinical data. Wideochir Inne Tech Maloinwazyjne 2020; 16:1-9. [PMID: 33786111 PMCID: PMC7991933 DOI: 10.5114/wiitm.2020.100678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/04/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction The benefit of three-dimensional (3D) visualization for liver disease is uncertain. Aim To evaluate the effectiveness and safety of 3D versus two-dimensional (2D) video-assisted hepatectomy for LD. Material and methods We searched PubMed, Embase, Cochrane Library, Medline, and Web of Science for studies addressing 3D versus 2D for 2D until 30 February 2020. Study-specific effect sizes and their 95% confidence intervals (CIs) were combined to calculate the pooled value using a fixed-effects or random-effects model. Results Nine studies with 808 patients were included. The 3D group had shorter operative time (mean difference (MD) = 34.39; 95% CI = 59.50, 9.28), experienced less intraoperative blood loss (MD = 106.55; 95% CI = 183.76, 29.34), and a smaller blood transfusion volume (MD = 88.25; 95% CI = 141.26, 35.24). The 3D group had a smaller difference between the predicted volume and the actual resected volume (MD = 103.25; 95% CI = 173.24, 33.26) and a lower rate of postoperative complications (odds ratio (OR) = 0.57; 95% CI: 0.35, 0.91). Conclusions During surgery, 3D video-assisted hepatectomy could effectively reduce operative time, intraoperative bleeding, and blood transfusion volume, and had a smaller difference between the predicted volume and the actual resected volume and a lower rate of postoperative complications. More high-quality randomized controlled trials are required to verify the reliability and validity of our conclusion.
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14
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Cerciello F, Choi M, Sinicropi-Yao SL, Lomeo K, Amann JM, Felley-Bosco E, Stahel RA, Robinson BWS, Creaney J, Pass HI, Vitek O, Carbone DP. Verification of a Blood-Based Targeted Proteomics Signature for Malignant Pleural Mesothelioma. Cancer Epidemiol Biomarkers Prev 2020; 29:1973-1982. [PMID: 32732250 PMCID: PMC7541795 DOI: 10.1158/1055-9965.epi-20-0543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/18/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We have verified a mass spectrometry (MS)-based targeted proteomics signature for the detection of malignant pleural mesothelioma (MPM) from the blood. METHODS A seven-peptide biomarker MPM signature by targeted proteomics in serum was identified in a previous independent study. Here, we have verified the predictive accuracy of a reduced version of that signature, now composed of six-peptide biomarkers. We have applied liquid chromatography-selected reaction monitoring (LC-SRM), also known as multiple-reaction monitoring (MRM), for the investigation of 402 serum samples from 213 patients with MPM and 189 cancer-free asbestos-exposed donors from the United States, Australia, and Europe. RESULTS Each of the biomarkers composing the signature was independently informative, with no apparent functional or physical relation to each other. The multiplexing possibility offered by MS proteomics allowed their integration into a single signature with a higher discriminating capacity than that of the single biomarkers alone. The strategy allowed in this way to increase their potential utility for clinical decisions. The signature discriminated patients with MPM and asbestos-exposed donors with AUC of 0.738. For early-stage MPM, AUC was 0.765. This signature was also prognostic, and Kaplan-Meier analysis showed a significant difference between high- and low-risk groups with an HR of 1.659 (95% CI, 1.075-2.562; P = 0.021). CONCLUSIONS Targeted proteomics allowed the development of a multianalyte signature with diagnostic and prognostic potential for MPM from the blood. IMPACT The proteomic signature represents an additional diagnostic approach for informing clinical decisions for patients at risk for MPM.
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Affiliation(s)
- Ferdinando Cerciello
- James Thoracic Center, James Cancer Center, The Ohio State University Medical Center, Columbus, Ohio.
| | - Meena Choi
- College of Computer and Information Science, Northeastern University, Boston, Massachusetts
| | - Sara L Sinicropi-Yao
- James Thoracic Center, James Cancer Center, The Ohio State University Medical Center, Columbus, Ohio
| | - Katie Lomeo
- James Thoracic Center, James Cancer Center, The Ohio State University Medical Center, Columbus, Ohio
| | - Joseph M Amann
- James Thoracic Center, James Cancer Center, The Ohio State University Medical Center, Columbus, Ohio
| | - Emanuela Felley-Bosco
- Laboratory of Molecular Oncology, Division of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Rolf A Stahel
- Department of Oncology, Center of Hematology and Oncology, Comprehensive Cancer Center Zürich, University Hospital Zürich, Zürich, Switzerland
| | - Bruce W S Robinson
- National Centre for Asbestos Related Disease, University of Western Australia, School of Medicine and Pharmacology, Nedlands, Western Australia
| | - Jenette Creaney
- National Centre for Asbestos Related Disease, University of Western Australia, School of Medicine and Pharmacology, Nedlands, Western Australia
| | - Harvey I Pass
- New York University, Langone Medical Center, New York, New York
| | - Olga Vitek
- College of Computer and Information Science, Northeastern University, Boston, Massachusetts
| | - David P Carbone
- James Thoracic Center, James Cancer Center, The Ohio State University Medical Center, Columbus, Ohio.
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15
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Abstract
BACKGROUND Pleural Mesothelioma (PM) is an unusual, belligerent tumor that rapidly develops into cancer in the pleura of the lungs. Pleural Mesothelioma is a common type of Mesothelioma that accounts for about 75% of all Mesothelioma diagnosed yearly in the U.S. Diagnosis of Mesothelioma takes several months and is expensive. Given the risk and constraints associated with PM diagnosis, early identification of this ailment is essential for patient health. OBJECTIVE In this study, we use artificial intelligence algorithms recommending the best fit model for early diagnosis and prognosis of Malignant Pleural Mesothelioma (MPM). METHODS We retrospectively retrieved patients' clinical data collected by Dicle University, Turkey and applied multilayered perceptron (MLP), voted perceptron (VP), Clojure classifier (CC), kernel logistic regression (KLR), stochastic gradient decent (SGD), adaptive boosting (AdaBoost), Hoeffding tree (VFDT), and primal estimated sub-gradient solver for support vector machine (s-Pegasos). We evaluated the models, compared and tested them using paired t-test (corrected) at 0.05 significance based on their respective classification accuracy, f-measure, precision, recall, root mean squared error, receivers' characteristic curve (ROC), and precision-recall curve (PRC). RESULTS In phase 1, SGD, AdaBoost.M1, KLR, MLP, VFDT generate optimal results with the highest possible performance measures. In phase 2, AdaBoost, with a classification accuracy of 71.29%, outperformed all other algorithms. C-reactive protein, platelet count, duration of symptoms, gender, and pleural protein were found to be the most relevant predictors that can prognosticate Mesothelioma. CONCLUSION This study confirms that data obtained from biopsy and imaging tests are strong predictors of Mesothelioma but are associated with a high cost; however, they can identify Mesothelioma with optimal accuracy.
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16
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Gudmundsson E, Straus CM, Li F, Armato SG. Deep learning-based segmentation of malignant pleural mesothelioma tumor on computed tomography scans: application to scans demonstrating pleural effusion. J Med Imaging (Bellingham) 2020; 7:012705. [PMID: 32016133 DOI: 10.1117/1.jmi.7.1.012705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 12/24/2019] [Indexed: 12/29/2022] Open
Abstract
Tumor volume is a topic of interest for the prognostic assessment, treatment response evaluation, and staging of malignant pleural mesothelioma. Many mesothelioma patients present with, or develop, pleural fluid, which may complicate the segmentation of this disease. Deep convolutional neural networks (CNNs) of the two-dimensional U-Net architecture were trained for segmentation of tumor in the left and right hemithoraces, with the networks initialized through layers pretrained on ImageNet. Networks were trained on a dataset of 5230 axial sections from 154 CT scans of 126 mesothelioma patients. A test set of 94 CT sections from 34 patients, who all presented with both tumor and pleural effusion, in addition to a more general test set of 130 CT sections from 43 patients, were used to evaluate segmentation performance of the deep CNNs. The Dice similarity coefficient (DSC), average Hausdorff distance, and bias in predicted tumor area were calculated through comparisons with radiologist-provided tumor segmentations on the test sets. The present method achieved a median DSC of 0.690 on the tumor and effusion test set and achieved significantly higher performance on both test sets when compared with a previous deep learning-based segmentation method for mesothelioma.
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Affiliation(s)
- Eyjolfur Gudmundsson
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Christopher M Straus
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Feng Li
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Samuel G Armato
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
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17
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Abstract
Malignant pleural mesothelioma (MPM) is a rare malignancy with some unique characteristics. Tumor biology is aggressive and prognosis is poor. Despite more knowledge on histology, tumor biology and staging, there is still a relevant discrepancy between clinical and pathologic staging resulting in difficult prediction of prognosis and treatment outcome, making treatment allocation more challenging than in most other malignancies. After years of nihilism in the late 80s, a period of activism started evaluating different treatment protocols combined with research driven mainly by academic centers; at the time, selection was based on histology and stage only. This period was important to gain knowledge about the disease. However, the interpretation of data was difficult since selection criteria and definitions varied substantially. Not surprisingly, until now there is no common agreement on best treatment even among specialists. Hence, a review of our current concepts is indicated and personalized treatment should become applicable in the future. Surgery was and still is an issue of debate. In principle, surgery is an effective approach as it allows macroscopic complete elimination of a tumor, which is relatively resistant to medical treatment. It helps to set the clock back and other therapies that have also just a limited effect can be applied sequentially before or after surgery. Furthermore, to date best long-term outcome is reported from surgical series in combination with other modalities. However, part of the community considers surgery associated with too high morbidity and mortality when balanced to the limited life expectancy. This criticism is understandable, since poor results after surgery are reported. The present article will review the indication for surgery and discuss the different procedures available for macroscopic complete resection-such as lung-preserving (extended) pleurectomy/decortication as well as extrapleural pneumonectomy to illustrate that 'The surgeon is still there!'
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Affiliation(s)
- I Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
| | - W Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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18
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Paajanen J, Ilonen I, Lauri H, Järvinen T, Sutinen E, Ollila H, Rouvinen E, Lemström K, Räsänen J, Ritvos O, Koli K, Myllärniemi M. Elevated Circulating Activin A Levels in Patients With Malignant Pleural Mesothelioma Are Related to Cancer Cachexia and Reduced Response to Platinum-based Chemotherapy. Clin Lung Cancer 2019; 21:e142-e150. [PMID: 31734071 DOI: 10.1016/j.cllc.2019.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/14/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Previous preclinical studies have shown that activin A is overexpressed in malignant pleural mesothelioma (MPM), associates with cancer cachexia, and is observed in in vitro resistance to platinum-based chemotherapy. We evaluated circulating activin levels and their endogenous antagonists' follistatin/follistatin-like 3 in intrathoracic tumors. MATERIALS AND METHODS Patients suspected of thoracic malignancy were recruited prior to surgery. Serum samples were collected from 21 patients with MPM, 59 patients with non-small-cell lung cancer (NSCLC), and 22 patients with benign lung lesions. Circulating activin/follistatin levels were measured using enzyme-linked immunosorbent assay and compared with clinicopathologic parameters. RESULTS Circulating activin A levels were elevated in patients with MPM when compared with patients with NSCLC or benign lung lesion samples (P < .0001). Also, follistatin and follistatin-like 3 levels were the highest in MPM, although with less difference compared with activin A. Receiver operating characteristic analysis for activin A for separating NSCLC from benign lung lesion showed an area under the curve of 0.856 (95% confidence interval, 0.77-0.94). Activin A levels were higher in patients with cachexia (P < .001). In patients with MPM, activin A levels correlated positively with computed tomography-based baseline tumor size (R = 0.549; P = .010) and the change in tumor size after chemotherapy (R = 0.743; P = .0006). Patients with partial response or stable disease had lower circulating activin A levels than the ones with progressive disease (P = .028). CONCLUSION Activin A serum level could be used as a biomarker in differentiating malignant and benign lung tumors. Circulating activin A levels were elevated in MPM and associates with cancer cachexia and reduced chemotherapy response.
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Affiliation(s)
- Juuso Paajanen
- Department of Pulmonary Medicine, Helsinki University Hospital, Helsinki, Finland; Individualized Drug Therapy, Research Programs Unit, Medical Faculty, University of Helsinki, Helsinki, Finland.
| | - Ilkka Ilonen
- Department of Cardiothoracic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Individualized Drug Therapy, Research Programs Unit, Medical Faculty, University of Helsinki, Helsinki, Finland
| | - Helena Lauri
- Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tommi Järvinen
- Department of Cardiothoracic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eva Sutinen
- Department of Pulmonary Medicine, Helsinki University Hospital, Helsinki, Finland; Individualized Drug Therapy, Research Programs Unit, Medical Faculty, University of Helsinki, Helsinki, Finland
| | - Hely Ollila
- Individualized Drug Therapy, Research Programs Unit, Medical Faculty, University of Helsinki, Helsinki, Finland
| | - Eeva Rouvinen
- Department of Pulmonary Medicine, Helsinki University Hospital, Helsinki, Finland; Transplantation Immunology Program, Research Programs Unit, Medical Faculty, University of Helsinki, Helsinki, Finland
| | - Karl Lemström
- Department of Cardiothoracic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Transplantation Immunology Program, Research Programs Unit, Medical Faculty, University of Helsinki, Helsinki, Finland
| | - Jari Räsänen
- Department of Cardiothoracic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Olli Ritvos
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Katri Koli
- Individualized Drug Therapy, Research Programs Unit, Medical Faculty, University of Helsinki, Helsinki, Finland
| | - Marjukka Myllärniemi
- Department of Pulmonary Medicine, Helsinki University Hospital, Helsinki, Finland; Individualized Drug Therapy, Research Programs Unit, Medical Faculty, University of Helsinki, Helsinki, Finland
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Gill RR, Tsao AS, Kindler HL, Richards WG, Armato SG, Francis RJ, Gomez DR, Dahlberg S, Rimner A, Simone CB, de Perrot M, Blumenthal G, Adjei AA, Bueno R, Harpole DH, Hesdorffer M, Hirsch FR, Pass HI, Yorke E, Rosenzweig K, Burt B, Fennell DA, Lindwasser W, Malik S, Peikert T, Mansfield AS, Salgia R, Yang H, Rusch VW, Nowak AK. Radiologic Considerations and Standardization of Malignant Pleural Mesothelioma Imaging Within Clinical Trials: Consensus Statement from the NCI Thoracic Malignancy Steering Committee - International Association for the Study of Lung Cancer - Mesothelioma Applied Research Foundation Clinical Trials Planning Meeting. J Thorac Oncol 2019; 14:1718-1731. [PMID: 31470129 DOI: 10.1016/j.jtho.2019.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/26/2019] [Accepted: 08/20/2019] [Indexed: 12/19/2022]
Abstract
Detailed guidelines pertaining to radiological assessment of malignant pleural mesothelioma are currently lacking due to the rarity of the disease, complex morphology, propensity to invade multiple planes simultaneously, and lack of specific recommendations within the radiology community about assessment, reporting, and follow-up. In March 2017, a multidisciplinary meeting of mesothelioma experts was co-sponsored by the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and the Mesothelioma Applied Research Foundation. One of the outcomes of this conference was the foundation of detailed, multidisciplinary consensus imaging and management guidelines. Here, we present the recommendations for radiologic assessment of malignant pleural mesothelioma in the setting of clinical trial enrollment. We discuss optimization of imaging parameters across modalities, standardized reporting, and response assessment within clinical trials.
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Affiliation(s)
- Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Anne S Tsao
- Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hedy L Kindler
- Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, Illinois
| | - William G Richards
- Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - Samuel G Armato
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - Roslyn J Francis
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital and Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Daniel R Gomez
- Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Suzanne Dahlberg
- Department of Biostatistics, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Andreas Rimner
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; Departments of Radiation Oncology, Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - Marc de Perrot
- Cancer Clinical Research Unit, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Gideon Blumenthal
- U.S. Food and Drug Administration, National Cancer Institute, Bethesda, Maryland
| | - Alex A Adjei
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Raphael Bueno
- Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - David H Harpole
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | | | - Fred R Hirsch
- Center for Thoracic Oncology, Mount Sinai Cancer, Mount Sinai Health System, New York, New York
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, NYU School of Medicine, New York, New York
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kenneth Rosenzweig
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
| | - Bryan Burt
- Department of Thoracic Surgery, Baylor College of Medicine, Houston, Texas
| | - Dean A Fennell
- Leicester Cancer Research Centre, University of Leicester, Leicester, United Kingdom
| | | | | | - Tobias Peikert
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Aaron S Mansfield
- U.S. Food and Drug Administration, National Cancer Institute, Bethesda, Maryland
| | - Ravi Salgia
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Haining Yang
- Department of Pathology, University of Hawaii, Honolulu, Hawaii
| | - Valerie W Rusch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anna K Nowak
- Department of Medicine, Sir Charles Gairdner Hospital and Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
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20
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Proto C, Signorelli D, Mallone S, Prelaj A, Lo Russo G, Imbimbo M, Galli G, Ferrara R, Ganzinelli M, Leuzzi G, Greco FG, Calareso G, Botta L, Gatta G, Garassino M, Trama A. The Prognostic Role of TNM Staging Compared With Tumor Volume and Number of Pleural Sites in Malignant Pleural Mesothelioma. Clin Lung Cancer 2019; 20:e652-e660. [PMID: 31377142 DOI: 10.1016/j.cllc.2019.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/25/2019] [Accepted: 06/15/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Age, sex, stage, histotype, and surgery are the most recognized prognostic factors for malignant pleural mesothelioma (MPM). Tumor volume (TV) was suggested as an alternative prognostic evaluation. We aimed to assess the prognostic role of Tumor, Node, Metastases (TNM) versus TV and number of pleural sites (NPS). PATIENTS AND METHODS Information on stage, TV, and NPS was collected for 52 MPM patients (pts) at our institution from 2009 to 2012. Baseline computed tomography imaging was performed to define TNM, TV, and NPS. Pts were divided in 3 stage groups: early (I-II), III, and IV. A dedicated computer system calculated TV. Pts were divided in 2 groups according to mean baseline TV (483 cm3). NPS was defined on the basis of the NPS macroscopically involved by disease (1-3). The association between TNM, tumor size (T), TV, NPS, TV and NPS, and overall survival was assessed using Cox models adjusted for age, sex, histology, and treatment. RESULTS Most pts were male; mean age was 62 years. We showed an association between TV, TNM, and T. Stage III (hazard ratio [HR], 4.71; P = .02) and IV (HR, 7.40; P < .01), T3 (HR, 5.07; P < .01) and T4 (HR, 5.09; P < .01), TV > 483 cm3 (HR, 3.47; P < .01) and NPS 2 (HR, 3.00; P = .08) and 3 (HR, 6.05; P < .01) were predictive of worse survival. However, the TV and NPS combination performed better than TV, NPS, and TNM alone as a prognostic classifier. CONCLUSION We showed that TV is related to TNM staging and T, in particular. Improved prognostic performance might be achievable using quantitative clinical staging combining TV and NPS.
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Affiliation(s)
- Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Sandra Mallone
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Arsela Prelaj
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Martina Imbimbo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Giulia Galli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Roberto Ferrara
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Monica Ganzinelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Giovanni Leuzzi
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Giuseppina Calareso
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Laura Botta
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Gemma Gatta
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Marina Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Annalisa Trama
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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21
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Gill RR, Yeap BY, Bueno R, Richards WG. Quantitative Clinical Staging for Patients With Malignant Pleural Mesothelioma. J Natl Cancer Inst 2019; 110:258-264. [PMID: 29931180 PMCID: PMC6009654 DOI: 10.1093/jnci/djx175] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/02/2017] [Indexed: 12/29/2022] Open
Abstract
Background Analysis of the International Association for the Study of Lung Cancer (IASLC) Malignant Pleural Mesothelioma (MPM) database revealed that clinical (cTNM) staging minimally stratified survival and was discrepant with pathological (pTNM) staging. To improve prognostic classification of MPM, alternative staging models based on quantitative parameters were explored. Methods An institutional review board–approved MPM registry was queried to identify patients with available pathological and preoperative imaging data. Qualifying patients were randomly assigned to training and test sets in a 1:2 ratio. Computed cTNM and pTNM staging (AJCC Cancer Staging Manual, 7th ed.) were compared. Quantitative image analysis included tumor volume assessed from three-dimensional reconstruction of computed tomography scans (VolCT) and maximal fissural thickness (Fmax). Survival was estimated using the Kaplan-Meier method, and the relationship with VolCT was examined by Cox regression analysis to identify optimized cut-points. Performance of cTNM and quantitative models derived was compared in the test set using Harrell’s C index. Results A total of 472 patients met inclusion criteria. TNM staging was concordant with pathological TNM staging in 171 of 472 (36.2%), understaged in 209 (44.2%), and overstaged in 92 (19.4%) patients. The most concordant feature was involvement of interlobar fissures. A quantitative clinical staging model comprising VolCT and Fmax (c-index = 0.638, 95% confidence interval [CI] = 0.603 to 0.673) performed statistically significantly better as a prognostic classifier when compared in the test set with cTNM (c-index = 0.562, 95% CI = 0.525 to 0.599, P = .001). Conclusions Improved prognostic performance may be achievable by quantitative clinical staging combining VolCT and Fmax, providing a cost-effective and clinically relevant surrogate for clinical TNM stage.
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Affiliation(s)
- Ritu R Gill
- Department of Radiology, Brigham and Women's, Hospital and Harvard Medical School, Boston, MA
| | - Beow Y Yeap
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women's, Hospital and Harvard Medical School, Boston, MA
| | - William G Richards
- Division of Thoracic Surgery, Brigham and Women's, Hospital and Harvard Medical School, Boston, MA
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Computed tomography features of local pleural recurrence in patients with malignant pleural mesothelioma treated with intensity-modulated pleural radiation therapy. Eur Radiol 2019; 29:3696-3704. [PMID: 30689034 DOI: 10.1007/s00330-018-5937-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/11/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study was conducted in order to describe the computed tomography (CT) features of local pleural recurrence in patients with malignant pleural mesothelioma undergoing intensity-modulated pleural radiation therapy (IMPRINT) as part of multimodality treatment. METHODS In this observational study, 58 patients treated with IMPRINT between September 21, 2004, and December 1, 2014 were included. Baseline and follow-up CT scans were qualitatively assessed. On follow-up scans, pleural thickening was categorized as unchanged, decreased, or new/increased. New/increased pleural abnormality was subcategorized as diffuse smooth pleural thickening, diffuse nodular pleural thickening, focal pleural nodule, or multiple pleural nodules. To identify features more frequently present at the time of local recurrence, follow-up scans with local recurrence were matched to four control scans; exact conditional logistic regression was performed. RESULTS Twenty-one (36%) patients had local pleural recurrence and 20 (34%) patients had nonpleural recurrence; 3 patients had both types of recurrence. The 1-year cumulative incidence rate of local recurrence was 27% (95% confidence interval 15, 39). On follow-up scans, three patterns of pleural abnormality were significantly associated with local recurrence: new/increased multiple pleural nodules (10 (48%) positive scans vs 0 control scans), new/increased diffuse nodular pleural thickening (7 (33%) positive scans vs 1 (1%) control scans), and new/increased focal pleural nodule (3 (14%) positive scans vs 1 (1%) control scan) (p < 0.001 for all). CONCLUSIONS Multiple new/increased pleural nodules are the feature most commonly present at local recurrence following IMPRINT; however, any pattern of increased nodular pleural thickening is suspicious. KEY POINTS • In patients with mesothelioma receiving intensity-modulated pleural radiation as part of multimodality therapy, increasing multiple pleural nodules is the computed tomography feature most commonly present at local recurrence. • In these patients, any CT pattern of increased nodular pleural thickening should be considered suspicious for local recurrence. • The most common sites of nonpleural recurrence were lung parenchyma, thoracic lymph nodes, and peritoneum.
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23
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Pleural thickness after neoadjuvant chemotherapy is a prognostic factor in malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2019; 157:404-413. [DOI: 10.1016/j.jtcvs.2018.09.106] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/24/2018] [Accepted: 09/11/2018] [Indexed: 11/17/2022]
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24
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Armato SG, Francis RJ, Katz SI, Ak G, Opitz I, Gudmundsson E, Blyth KG, Gupta A. Imaging in pleural mesothelioma: A review of the 14th International Conference of the International Mesothelioma Interest Group. Lung Cancer 2018; 130:108-114. [PMID: 30885330 DOI: 10.1016/j.lungcan.2018.11.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/25/2018] [Indexed: 01/02/2023]
Abstract
Mesothelioma patients rely on the information their clinical team obtains from medical imaging. Whether x-ray-based computed tomography (CT) or magnetic resonance imaging (MRI) based on local magnetic fields within a patient's tissues, different modalities generate images with uniquely different appearances and information content due to the physical differences of the image-acquisition process. Researchers are developing sophisticated ways to extract a greater amount of the information contained within these images. This paper summarizes the imaging-based research presented orally at the 2018 International Conference of the International Mesothelioma Interest Group (iMig) in Ottawa, Ontario, Canada, held May 2-5, 2018. Presented topics included advances in the imaging of preclinical mesothelioma models to inform clinical therapeutic strategies, optimization of the time delay between contrast administration and image acquisition for maximized enhancement of mesothelioma tumor on CT, an investigation of image-based criteria for clinical tumor and nodal staging of mesothelioma by contrast-enhanced CT, an investigation of methods for the extraction of mesothelioma tumor volume from MRI and the association of volume with patient survival, the use of deep learning for mesothelioma tumor segmentation in CT, and an evaluation of CT-based radiomics for the prognosis of mesothelioma patient survival.
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Affiliation(s)
- Samuel G Armato
- Department of Radiology, The University of Chicago, Chicago, Illinois, USA.
| | - Roslyn J Francis
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Faculty of Health and Medical Sciences, University of Western Australia Medical School, Australia
| | - Sharyn I Katz
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Guntulu Ak
- Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Kevin G Blyth
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK; Institute of Infection, Immunity & Inflammation, University of Glasgow, UK
| | - Ashish Gupta
- Department of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada
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25
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Berzenji L, Van Schil PE, Carp L. The eighth TNM classification for malignant pleural mesothelioma. Transl Lung Cancer Res 2018; 7:543-549. [PMID: 30450292 PMCID: PMC6204412 DOI: 10.21037/tlcr.2018.07.05] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/12/2018] [Indexed: 11/06/2022]
Abstract
In 2016, the International Association for the Study of Lung Cancer (IASLC) published a number of revisions of the seventh edition of the tumor, node and metastasis (TNM) classification for malignant pleural mesothelioma (MPM). The purpose was to establish a set of recommendations for the eighth edition of the TNM staging system. A large number of patients were included in the IASLC database and subsequently analysed to determine new definitions for the components of the TNM classification. A number of important changes were introduced for the T component. Survival analysis of the different T categories showed no significant difference in categories T1a and T1b. This has resulted in a collapse of categories T1a and T1b into one category T1. In addition, tumor thickness was also significantly associated with overall survival. The descriptors for the N components have been redefined as well for the eighth TNM classification. A major revision is the removal of category N3 in the N component. Both intrapleural and extrapleural (N1 and N2 in the seventh edition) are now combined into a single category N1. Lymph nodes that were previously categorized as N3 are now considered N2. For the M component, no redefinition has been published. However, a recommendation has been made to only consider M1 involvement as stage IV disease. This is in contrast to the seventh edition in which T4 and N3 disease were considered stage IV as well. In conclusion, a number of important revisions for the eighth TNM classification of MPM have been published as a result of this IASLC project. This type of large-scale and international joint efforts are key in establishing effective staging systems. Research into using tumor thickness as a prognostic instrument will be an important part of any future editions of the TNM classification.
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Affiliation(s)
- Lawek Berzenji
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul E. Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
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26
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Gudmundsson E, Straus CM, Armato SG. Deep convolutional neural networks for the automated segmentation of malignant pleural mesothelioma on computed tomography scans. J Med Imaging (Bellingham) 2018; 5:034503. [PMID: 30840717 DOI: 10.1117/1.jmi.5.3.034503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/24/2018] [Indexed: 12/29/2022] Open
Abstract
Tumor volume has been a topic of interest in the staging, prognostic evaluation, and treatment response assessment of malignant pleural mesothelioma (MPM). Deep convolutional neural networks (CNNs) were trained separately for the left and right hemithoraces on the task of differentiating between pleural thickening and normal thoracic tissue on computed tomography (CT) scans. A total of 4259 and 6192 axial sections containing segmented tumor were used to train the left-hemithorax CNN and the right-hemithorax CNN, respectively. Two distinct test sets of 131 sections from the CT scans of 43 patients were used to evaluate segmentation performance by calculating the Dice similarity coefficient (DSC) between deep CNN-generated tumor segmentations and reference tumor segmentations provided by a total of eight observers. Median DSC values ranged from 0.662 to 0.800 over the two test sets when comparing deep CNN-generated segmentations with observer reference segmentations. The deep CNN-based method achieved significantly higher DSC values for all three observers on the test set that allowed direct comparisons with a previously published automated segmentation method of MPM tumor on CT scans ( p < 0.0005 ). A deep CNN was implemented for the automated segmentation of MPM tumor on CT scans, showing superior performance to a previously published method.
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Affiliation(s)
- Eyjolfur Gudmundsson
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Christopher M Straus
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Samuel G Armato
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
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27
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Calabrò L, Morra A, Cornelissen R, Aerts J, Maio M. Immune checkpoint blockade therapy of mesothelioma: a clinical and radiological challenge. Cancer Immunol Immunother 2018; 67:1317-1324. [PMID: 29943157 PMCID: PMC11028073 DOI: 10.1007/s00262-018-2191-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 06/22/2018] [Indexed: 02/08/2023]
Abstract
Treatment of malignant pleural mesothelioma (MPM) represents a highly unmet medical need. Here, we discuss the results and therapeutic potential of first- and second-generation immunomodulatory antibodies targeting distinct immune checkpoints for the treatment of MPM, as well as their prospective therapeutic role in combination strategies. We also discuss the role of appropriate radiological criteria of response for MPM and the potential need of ad hoc criteria of disease evaluation in MPM patients undergoing treatment with immunotherapeutic agents.
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Affiliation(s)
- Luana Calabrò
- Medical Oncology and Immunotherapy, Center for Immuno-Oncology, University Hospital of Siena, Istituto Toscano Tumori, Siena, Viale Mario Bracci n. 16, 53100, Siena, Italy.
| | - Aldo Morra
- Department of Radiology, Euganea Medica Diagnostic Center, Padua, Italy
| | | | - Joachim Aerts
- Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Michele Maio
- Medical Oncology and Immunotherapy, Center for Immuno-Oncology, University Hospital of Siena, Istituto Toscano Tumori, Siena, Viale Mario Bracci n. 16, 53100, Siena, Italy
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28
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Dynamic contrast-enhanced CT for the assessment of tumour response in malignant pleural mesothelioma: a pilot study. Eur Radiol 2018; 29:682-688. [DOI: 10.1007/s00330-018-5533-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/25/2018] [Accepted: 05/11/2018] [Indexed: 10/28/2022]
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29
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Rastogi A, Maheshwari S, Shinagare AB, Baheti AD. Computed Tomography Advances in Oncoimaging. Semin Roentgenol 2018; 53:147-156. [PMID: 29861006 DOI: 10.1053/j.ro.2018.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ashita Rastogi
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, India
| | - Sharad Maheshwari
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - Atul B Shinagare
- Department of Radiology, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA
| | - Akshay D Baheti
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, India.
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30
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McCambridge AJ, Napolitano A, Mansfield AS, Fennell DA, Sekido Y, Nowak AK, Reungwetwattana T, Mao W, Pass HI, Carbone M, Yang H, Peikert T. Progress in the Management of Malignant Pleural Mesothelioma in 2017. J Thorac Oncol 2018; 13:606-623. [PMID: 29524617 PMCID: PMC6544834 DOI: 10.1016/j.jtho.2018.02.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 02/07/2023]
Abstract
Malignant pleural mesothelioma (MPM) is an uncommon, almost universally fatal, asbestos-induced malignancy. New and effective strategies for diagnosis, prognostication, and treatment are urgently needed. Herein we review the advances in MPM achieved in 2017. Whereas recent epidemiological data demonstrated that the incidence of MPM-related death continued to increase in United States between 2009 and 2015, new insight into the molecular pathogenesis and the immunological tumor microenvironment of MPM, for example, regarding the role of BRCA1 associated protein 1 and the expression programmed death receptor ligand 1, are highlighting new potential therapeutic strategies. Furthermore, there continues to be an ever-expanding number of clinical studies investigating systemic therapies for MPM. These trials are primarily focused on immunotherapy using immune checkpoint inhibitors alone or in combination with other immunotherapies and nonimmunotherapies. In addition, other promising targeted therapies, including pegylated adenosine deiminase (ADI-PEG20), which focuses on argininosuccinate synthase 1-deficient tumors, and tazemetostat, an enhancer of zeste 2 polycomb repressive complex 2 subunit inhibitor of BRCA1 associated protein 1 gene (BAP1)-deficient tumors, are currently being explored.
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Affiliation(s)
| | - Andrea Napolitano
- University of Hawaii Cancer Center, Honolulu, HI, USA
- Medical Oncology Department, Campus Bio-Medico, University of Rome,
Rome, Italy
| | | | - Dean A. Fennell
- Department of Genetics and Genome Biology, University of Leicester
& University Hospitals of Leicester, UK
| | - Yoshitaka Sekido
- Division of Molecular Oncology, Aichi Cancer Center Research
Institute, Chikusa-ku, Nagoya, Japan
| | - Anna K. Nowak
- Division of Medical Oncology, School of Medicine, Faculty of Health
and Medical Sciences; National Center for Asbestos Related Diseases, University of
Western Australia, Perth, Australia
| | - Thanyanan Reungwetwattana
- Division of Medical Oncology, Department of Medicine, Faculty of
Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital; Key
Laboratory Diagnosis and Treatment Technology on Thoracic Oncology of Zehjiang
Province, Hangzhou, China
| | - Harvey I. Pass
- Department of Cardiothoracic Surgery, New York University, Langone
Medical Center, New York, NY, USA
| | | | - Haining Yang
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Tobias Peikert
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic,
Rochester, MN, USA
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31
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Woolhouse I, Bishop L, Darlison L, De Fonseka D, Edey A, Edwards J, Faivre-Finn C, Fennell DA, Holmes S, Kerr KM, Nakas A, Peel T, Rahman NM, Slade M, Steele J, Tsim S, Maskell NA. British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma. Thorax 2018; 73:i1-i30. [PMID: 29444986 DOI: 10.1136/thoraxjnl-2017-211321] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Ian Woolhouse
- Department of Respiratory Medicine, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Lesley Bishop
- Department of Respiratory Medicine, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Liz Darlison
- Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | | | | | | | | | - Dean A Fennell
- University of Leicester & University Hospitals of Leicester, Leicester, UK
| | - Steve Holmes
- The Park Medical Practice, Shepton Mallet, Somerset, UK
| | | | - Apostolos Nakas
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Tim Peel
- North Tyneside General Hospital, North Shields, UK
| | - Najib M Rahman
- Oxford NIHR Biomedical Research, University of Oxford, Oxford, UK
| | - Mark Slade
- Papworth Hospital, Thoracic Oncology, Cambridge, UK
| | | | - Selina Tsim
- Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Nick A Maskell
- Academic Respiratory Unit, Bristol Medical School, University of Bristol, Bristol, UK
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32
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Shintani Y, Hasegawa S, Takuwa T, Aoe K, Kato K, Fujimoto N, Hida Y, Morise M, Moriya Y, Morohoshi T, Okumura M, Yoshino I. Prospective registry database of patients with malignant mesothelioma: directions for a future Japanese registry-based lung cancer study. J Thorac Dis 2018; 10:1968-1971. [PMID: 29707353 DOI: 10.21037/jtd.2018.03.53] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The International Association for the Study of Lung Cancer, in collaboration with members of the International Mesothelioma Interest Group (IMIG), developed a large international database and TNM-based system to study malignant pleural mesothelioma (MPM). However, this database has some limitations since it was a retrospective study and it was based predominantly on surgical cases. The Japanese Joint Committee of Lung Cancer Registry (JJCLCR) employs a project of prospective registry database of patients in Japan with MPM in order to clarify MPM's epidemiology, current management practices, and prognosis and also to investigate the potential capabilities to target the best patients for therapy. Methods Tumor stage is described using the 7th and 8th versions of IMIG staging system. This prospective cohort study has been conducted from April 1, 2017 to March 31, 2019. Discussion We will analyze the data in this registry to determine the most recent outcomes and trends related to MPM treatment in Japan. The present prospective study is expected to validate the 8th version of IMIG staging system, and to investigate whether tumor thickness is a reliable T-descriptor. Trial registration ClinicalTrials.gov Identifier: UMIN 000024664.
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Affiliation(s)
- Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Teruhisa Takuwa
- Department of Thoracic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Keisuke Aoe
- Department of Medical Oncology, National Hospital Organization Yamaguchi-Ube Medical Center, Yamaguchi, Japan
| | - Katsuya Kato
- Department of Diagnostic Radiology 2, Kawasaki Medical School, Okayama, Japan
| | - Nobukazu Fujimoto
- Department of Medical Oncology, Okayama Rosai Hospital, Okayama, Japan
| | - Yasuhiro Hida
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Masahiro Morise
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yasumitsu Moriya
- Division of General Thoracic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Takao Morohoshi
- Division of General Thoracic Surgery, Yokosuka-Kyosai Hospital, Kanagawa, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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33
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Kidd AC, McGettrick M, Tsim S, Halligan DL, Bylesjo M, Blyth KG. Survival prediction in mesothelioma using a scalable Lasso regression model: instructions for use and initial performance using clinical predictors. BMJ Open Respir Res 2018; 5:e000240. [PMID: 29468073 PMCID: PMC5812388 DOI: 10.1136/bmjresp-2017-000240] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/28/2017] [Accepted: 12/08/2017] [Indexed: 12/14/2022] Open
Abstract
Introduction Accurate prognostication is difficult in malignant pleural mesothelioma (MPM). We developed a set of robust computational models to quantify the prognostic value of routinely available clinical data, which form the basis of published MPM prognostic models. Methods Data regarding 269 patients with MPM were allocated to balanced training (n=169) and validation sets (n=100). Prognostic signatures (minimal length best performing multivariate trained models) were generated by least absolute shrinkage and selection operator regression for overall survival (OS), OS <6 months and OS <12 months. OS prediction was quantified using Somers DXY statistic, which varies from 0 to 1, with increasing concordance between observed and predicted outcomes. 6-month survival and 12-month survival were described by area under the curve (AUC) scores. Results Median OS was 270 (IQR 140-450) days. The primary OS model assigned high weights to four predictors: age, performance status, white cell count and serum albumin, and after cross-validation performed significantly better than would be expected by chance (mean DXY0.332 (±0.019)). However, validation set DXY was only 0.221 (0.0935-0.346), equating to a 22% improvement in survival prediction than would be expected by chance. The 6-month and 12-month OS signatures included the same four predictors, in addition to epithelioid histology plus platelets and epithelioid histology plus C-reactive protein (mean AUC 0.758 (±0.022) and 0.737 (±0.012), respectively). The <6-month OS model demonstrated 74% sensitivity and 68% specificity. The <12-month OS model demonstrated 63% sensitivity and 79% specificity. Model content and performance were generally comparable with previous studies. Conclusions The prognostic value of the basic clinical information contained in these, and previously published models, is fundamentally of limited value in accurately predicting MPM prognosis. The methods described are suitable for expansion using emerging predictors, including tumour genomics and volumetric staging.
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Affiliation(s)
- Andrew C Kidd
- Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Selina Tsim
- Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | | | | | - Kevin G Blyth
- Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK.,Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Kindler HL, Ismaila N, Armato SG, Bueno R, Hesdorffer M, Jahan T, Jones CM, Miettinen M, Pass H, Rimner A, Rusch V, Sterman D, Thomas A, Hassan R. Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2018; 36:1343-1373. [PMID: 29346042 DOI: 10.1200/jco.2017.76.6394] [Citation(s) in RCA: 258] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To provide evidence-based recommendations to practicing physicians and others on the management of malignant pleural mesothelioma. Methods ASCO convened an Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, pathology, imaging, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1990 through 2017. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. Results The literature search identified 222 relevant studies to inform the evidence base for this guideline. Recommendations Evidence-based recommendations were developed for diagnosis, staging, chemotherapy, surgical cytoreduction, radiation therapy, and multimodality therapy in patients with malignant pleural mesothelioma. Additional information is available at www.asco.org/thoracic-cancer-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Hedy L Kindler
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nofisat Ismaila
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel G Armato
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Raphael Bueno
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mary Hesdorffer
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thierry Jahan
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Clyde Michael Jones
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Markku Miettinen
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Harvey Pass
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andreas Rimner
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie Rusch
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel Sterman
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anish Thomas
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Raffit Hassan
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
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Liver resection for HCC outside the BCLC criteria. Langenbecks Arch Surg 2017; 403:37-44. [PMID: 29199380 DOI: 10.1007/s00423-017-1640-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 11/21/2017] [Indexed: 01/27/2023]
Abstract
PURPOSE Surgical resection still remains the mainstay of management of hepatocellular carcinoma (HCC). At present, Barcelona clinic liver cancer (BCLC) staging is the most widely used tool to guide treatment; however, criteria for offering surgery as curative treatment are restrictive. We aimed to evaluate short-term and long-term outcomes of HCC after resection, even for patients outside BCLC criteria for resection. METHODS Data was collected from a prospective database from GI and HPB Department, Tata Memorial Hospital, Mumbai. Study period was from June 2010 to June 2015. RESULTS One hundred three patients of HCC were operated during this period, of which 100 underwent complete resection. Patients were staged according to the BCLC classification (BCLC stage A-25, B-64, C-11). Preoperative therapy was administered in 36 (36%) patients. At median follow-up of 21 months, overall 3-year survival for BCLC stages A, B, and C was 55.2, 62.7, and 37.5%, respectively. CONCLUSION In today's era of liver transplantation, resection (especially for larger tumors) may still be the preferred treatment option, considering problems and difficulties in donor availability, cost, and long waiting list for liver transplant. With evolving modern surgical technique, long-term survival benefit can be achieved with acceptable safety in most BCLC stage B and selected BCLC stage C patients and those who either do not fit into the transplant criteria or cannot afford transplant. Carefully designed trials are required to further elucidate these results.
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Klikovits T, Stockhammer P, Laszlo V, Dong Y, Hoda MA, Ghanim B, Opitz I, Frauenfelder T, Nguyen-Kim TDL, Weder W, Berger W, Grusch M, Aigner C, Klepetko W, Dome B, Renyi-Vamos F, Oehler R, Hegedus B. Circulating complement component 4d (C4d) correlates with tumor volume, chemotherapeutic response and survival in patients with malignant pleural mesothelioma. Sci Rep 2017; 7:16456. [PMID: 29184132 PMCID: PMC5705645 DOI: 10.1038/s41598-017-16551-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 11/03/2017] [Indexed: 12/29/2022] Open
Abstract
Only limited information is available on the role of complement activation in malignant pleural mesothelioma (MPM). Thus, we investigated the circulating and tissue levels of the complement component 4d (C4d) in MPM. Plasma samples from 55 MPM patients, 21 healthy volunteers (HV) and 14 patients with non-malignant pleural diseases (NMPD) were measured by ELISA for C4d levels. Tissue specimens from 32 patients were analyzed by C4d immunohistochemistry. Tumor volumetry was measured in 20 patients. We found no C4d labeling on tumor cells, but on ectopic lymphoid structures within the tumor stroma. Plasma C4d levels did not significantly differ between MPM, HV or NMPD. Late-stage MPM patients had higher plasma C4d levels compared to early-stage (p = 0.079). High circulating C4d was associated with a higher tumor volume (p = 0.047). Plasma C4d levels following induction chemotherapy were significantly higher in patients with stable/progressive disease compared to those with partial/major response (p = 0.005). Strikingly, patients with low C4d levels at diagnosis had a significantly better overall survival, confirmed in a multivariate cox regression model (hazard ratio 0.263, p = 0.01). Our findings suggest that circulating plasma C4d is a promising new prognostic biomarker in patients with MPM and, moreover, helps to select patients for surgery following induction chemotherapy.
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Affiliation(s)
- Thomas Klikovits
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Paul Stockhammer
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Viktoria Laszlo
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Yawen Dong
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Mir Alireza Hoda
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bahil Ghanim
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Frauenfelder
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Thi Dan Linh Nguyen-Kim
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Walter Berger
- Institute of Cancer Research, Comprehensive Cancer Center Vienna, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria
| | - Michael Grusch
- Institute of Cancer Research, Comprehensive Cancer Center Vienna, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria
| | - Clemens Aigner
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Department of Thoracic Surgery, Ruhrlandklinik, University Hospital Essen, Tueschener Weg 40, 45239, Essen, Germany
| | - Walter Klepetko
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Balazs Dome
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- National Koranyi Institute of Pulmonology, Piheno út 1, 1121, Budapest, Hungary
- Department of Thoracic Surgery, National Institute of Oncology and Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
| | - Ferenc Renyi-Vamos
- Department of Thoracic Surgery, National Institute of Oncology and Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
| | - Rudolf Oehler
- Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Balazs Hegedus
- Translational Thoracic Oncology Laboratory, Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Department of Thoracic Surgery, Ruhrlandklinik, University Hospital Essen, Tueschener Weg 40, 45239, Essen, Germany.
- MTA-SE Molecular Oncology Research Group, Hungarian Academy of Sciences - Semmelweis University, Üllői út 26, 1085, Budapest, Hungary.
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Choi YR, Kim JH, Park SJ, Hur BY, Han JK. Therapeutic response assessment using 3D ultrasound for hepatic metastasis from colorectal cancer: Application of a personalized, 3D-printed tumor model using CT images. PLoS One 2017; 12:e0182596. [PMID: 28797089 PMCID: PMC5552302 DOI: 10.1371/journal.pone.0182596] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 07/23/2017] [Indexed: 12/13/2022] Open
Abstract
Background & aims To evaluate accuracy and reliability of three-dimensional ultrasound (3D US) for response evaluation of hepatic metastasis from colorectal cancer (CRC) using a personalized 3D-printed tumor model. Methods Twenty patients with liver metastasis from CRC who underwent baseline and after chemotherapy CT, were retrospectively included. Personalized 3D-printed tumor models using CT were fabricated. Two radiologists measured volume of each 3D printing model using 3D US. With CT as a reference, we compared difference between CT and US tumor volume. The response evaluation was based on Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Results 3D US tumor volume showed no significant difference from CT volume (7.18 ± 5.44 mL, 8.31 ± 6.32 mL vs 7.42 ± 5.76 mL in CT, p>0.05). 3D US provided a high correlation coefficient with CT (r = 0.953, r = 0.97) as well as a high inter-observer intraclass correlation (0.978; 0.958–0.988). Regarding response, 3D US was in agreement with CT in 17 and 18 out of 20 patients for observer 1 and 2 with excellent agreement (κ = 0.961). Conclusions 3D US tumor volume using a personalized 3D-printed model is an accurate and reliable method for the response evaluation in comparison with CT tumor volume.
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Affiliation(s)
- Ye Ra Choi
- Department of Radiology, Boramae Medical Center, Seoul, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
| | - Sang Joon Park
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Bo Yun Hur
- Department of Radiology, National Cancer Center, Gyeonggi-do, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Brahim W, Mestiri M, Betrouni N, Hamrouni K. Malignant pleural mesothelioma segmentation for photodynamic therapy planning. Comput Med Imaging Graph 2017; 65:79-92. [PMID: 28789867 DOI: 10.1016/j.compmedimag.2017.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/19/2017] [Accepted: 05/30/2017] [Indexed: 11/15/2022]
Abstract
Medical imaging modalities such as computed tomography (CT) combined with computer-aided diagnostic processing have already become important part of clinical routine specially for pleural diseases. The segmentation of the thoracic cavity represents an extremely important task in medical imaging for different reasons. Multiple features can be extracted by analyzing the thoracic cavity space and these features are signs of pleural diseases including the malignant pleural mesothelioma (MPM) which is the main focus of our research. This paper presents a method that detects the MPM in the thoracic cavity and plans the photodynamic therapy in the preoperative phase. This is achieved by using a texture analysis of the MPM region combined with a thoracic cavity segmentation method. The algorithm to segment the thoracic cavity consists of multiple stages. First, the rib cage structure is segmented using various image processing techniques. We used the segmented rib cage to detect feature points which represent the thoracic cavity boundaries. Next, the proposed method segments the structures of the inner thoracic cage and fits 2D closed curves to the detected pleural cavity features in each slice. The missing bone structures are interpolated using a prior knowledge from manual segmentation performed by an expert. Next, the tumor region is segmented inside the thoracic cavity using a texture analysis approach. Finally, the contact surface between the tumor region and the thoracic cavity curves is reconstructed in order to plan the photodynamic therapy. Using the adjusted output of the thoracic cavity segmentation method and the MPM segmentation method, we evaluated the contact surface generated from these two steps by comparing it to the ground truth. For this evaluation, we used 10 CT scans with pathologically confirmed MPM at stages 1 and 2. We obtained a high similarity rate between the manually planned surface and our proposed method. The average value of Jaccard index was about 0.79 and we obtained a value of 0.88 using the Dice index.
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Affiliation(s)
- Wael Brahim
- Université de Tunis El Manar, Ecole Nationale d'Ingénieurs de Tunis, LR-SITI Signal Image et Technologies de l'Information, 1002 Tunis, Tunisia.
| | - Makram Mestiri
- Université de Tunis El Manar, Ecole Nationale d'Ingénieurs de Tunis, LR-SITI Signal Image et Technologies de l'Information, 1002 Tunis, Tunisia.
| | - Nacim Betrouni
- The French National Institute of Health and Medical Research (Inserm), Lille, France
| | - Kamel Hamrouni
- Université de Tunis El Manar, Ecole Nationale d'Ingénieurs de Tunis, LR-SITI Signal Image et Technologies de l'Information, 1002 Tunis, Tunisia.
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Bellomi M, De Piano F, Ancona E, Lodigiani AF, Curigliano G, Raimondi S, Preda L. Evaluation of inter-observer variability according to RECIST 1.1 and its influence on response classification in CT measurement of liver metastases. Eur J Radiol 2017; 95:96-101. [PMID: 28987705 DOI: 10.1016/j.ejrad.2017.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/28/2017] [Accepted: 08/02/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study is the evaluation of inter-observer variability in the measurement of liver metastases according to RECIST and its influence on response classification. PATIENTS AND METHODS A total of 100 radiologists measured liver target lesions, on pre- and post-chemotherapy CT scans of three patients. Each observer filled out a questionnaire about his personal and work features. The evaluations of a well experienced radiologist, considered as "the gold standard", were compared to those taken by the observers. The percentage of the observers in agreement with the reviewer, in terms of the response category and in terms of inter-observer variability, was calculated for each patient. RESULTS The percentage of the inter-observer agreement was elevated. Most of the observers in agreement with the reviewer were senior radiologists, while those who disagreed were junior radiologist, but this result did not reach a statistical significance. More than 30% of observers disagreed with the reviewer at least in one of the three cases. CONCLUSIONS RECIST measurements are reproducible on a large and heterogeneous population of radiologists. Age and expertise of the radiologist remain the most critical factors: this suggests a revision by well-experienced radiologists in clinical trials.
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Affiliation(s)
- Massimo Bellomi
- Department of Radiological Science and Radiation Therapy, IEO European Institute of Oncology, Milan, Italy; Department of Oncology, Università degli Studi di Milano, Milan, Italy.
| | - Francesca De Piano
- Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Milan, Italy.
| | - Eleonora Ancona
- Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Milan, Italy.
| | - Alessandra Ferla Lodigiani
- Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Milan, Italy; Present address: Department of Imaging, CDI Centro Diagnostico Italiano, Via Simone Saint Bon, Milan, Italy.
| | - Giuseppe Curigliano
- New Drugs and Early Drug Development for Innovative Therapies Division, IEO European Institute of Oncology, Milan, Italy.
| | - Sara Raimondi
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology, Milan, Italy.
| | - Lorenzo Preda
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia and Division of Radiology, National Center of Oncological Hadrontherapy (CNAO Foundation), Italy.
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Murphy DJ, Gill RR. Volumetric assessment in malignant pleural mesothelioma. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:241. [PMID: 28706909 DOI: 10.21037/atm.2017.05.23] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Malignant pleural mesothelioma (MPM) is a highly malignant pleural neoplasm with a dismal prognosis. Multimodality approach including surgery and chemotherapy are utilized to treat patients with resectable disease. Clinical staging allows for selection of patients for treatment strategies, but has not been found to be prognostic and is plagued by high interobserver variability. Tumor volume measurement on cross-sectional imaging has emerged as a potential quantitative tool with prognostic significance. This review focuses on volumetric assessment from cross-sectional imaging (CT, MRI, 18F-FDG PET/CT) and the potential prognostic benefit and applications.
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Affiliation(s)
- David J Murphy
- Division of Thoracic Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ritu R Gill
- Division of Thoracic Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Scherpereel A. Malignant pleural mesothelioma: new treatments, new hopes? Eur Respir J 2017; 49:49/3/1700319. [PMID: 28298408 DOI: 10.1183/13993003.00319-2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Arnaud Scherpereel
- Pulmonary and Thoracic Oncology, CHU Lille, University of Lille, Lille, France .,French National network of clinical expert centres for malignant pleural mesothelioma management (MESOCLIN)
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Value of contrast CT in combination with PET/CT in mesothelioma staging: Optimal protocol for initial assessment. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2016.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Chen M, Helm E, Joshi N, Gleeson F, Brady M. Computer-aided volumetric assessment of malignant pleural mesothelioma on CT using a random walk-based method. Int J Comput Assist Radiol Surg 2016; 12:529-538. [PMID: 28028655 PMCID: PMC5362666 DOI: 10.1007/s11548-016-1511-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/08/2016] [Indexed: 10/29/2022]
Abstract
OBJECTIVE The aim of this study is to assess the performance of a computer-aided semi-automated algorithm we have adapted for the purpose of segmenting malignant pleural mesothelioma (MPM) on CT. METHODS Forty-five CT scans were collected from 15 patients (M:F [Formula: see text] 10:5, mean age 62.8 years) in a multi-centre clinical drug trial. A computer-aided random walk-based algorithm was applied to segment the tumour; the results were then compared to radiologist-drawn contours and correlated with measurements made using the MPM-adapted Response Evaluation Criteria in Solid Tumour (modified RECIST). RESULTS A mean accuracy (Sørensen-Dice index) of 0.825 (95% CI [0.758, 0.892]) was achieved. Compared to a median measurement time of 68.1 min (range [40.2, 102.4]) for manual delineation, the median running time of our algorithm was 23.1 min (range [10.9, 37.0]). A linear correlation (Pearson's correlation coefficient: 0.6392, [Formula: see text]) was established between the changes in modified RECIST and computed tumour volume. CONCLUSION Volumetric tumour segmentation offers a potential solution to the challenges in quantifying MPM. Computer-assisted methods such as the one presented in this study facilitate this in an accurate and time-efficient manner and provide additional morphological information about the tumour's evolution over time.
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Affiliation(s)
- Mitchell Chen
- Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, England. .,The Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Headington, OX3 7LE, England.
| | - Emma Helm
- The Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Headington, OX3 7LE, England
| | - Niranjan Joshi
- Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, England
| | - Fergus Gleeson
- The Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Headington, OX3 7LE, England
| | - Michael Brady
- Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, England
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Tsim S, Kelly C, Alexander L, McCormick C, Thomson F, Woodward R, Foster JE, Stobo DB, Paul J, Maskell NA, Chalmers A, Blyth KG. Diagnostic and Prognostic Biomarkers in the Rational Assessment of Mesothelioma (DIAPHRAGM) study: protocol of a prospective, multicentre, observational study. BMJ Open 2016; 6:e013324. [PMID: 27884852 PMCID: PMC5168514 DOI: 10.1136/bmjopen-2016-013324] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Malignant pleural mesothelioma (MPM) is an asbestos-related cancer, which is difficult to diagnose. Thoracoscopy is frequently required but is not widely available. An accurate, non-invasive diagnostic biomarker would allow early specialist referral, limit diagnostic delays and maximise clinical trial access. Current markers offer insufficient sensitivity and are not routinely used. The SOMAmer proteomic classifier and fibulin-3 have recently demonstrated sensitivity and specificity exceeding 90% in retrospective studies. DIAPHRAGM (Diagnostic and Prognostic Biomarkers in the Rational Assessment of Mesothelioma) is a suitably powered, multicentre, prospective observational study designed to determine whether these markers provide clinically useful diagnostic and prognostic information. METHODS AND ANALYSIS Serum and plasma (for SOMAscan and fibulin-3, respectively) will be collected at presentation, prior to pleural biopsy/pleurodesis, from 83 to 120 patients with MPM, at least 480 patients with non-MPM pleural disease and 109 asbestos-exposed controls. Final numbers of MPM/non-MPM cases will depend on the incidence of MPM in the study population (estimated at 13-20%). Identical sampling and storage protocols will be used in 22 recruiting centres and histological confirmation sought in all cases. Markers will be measured using the SOMAscan proteomic assay (SomaLogic) and a commercially available fibulin-3 ELISA (USCN Life Science). The SE in the estimated sensitivity and specificity will be <5% for each marker and their performance will be compared with serum mesothelin. Blood levels will be compared with paired pleural fluid levels and MPM tumour volume (using MRI) in a nested substudy. The prognostic value of each marker will be assessed and a large bioresource created. ETHICS AND DISSEMINATION The study has been approved by the West of Scotland Research Ethics Committee (Ref: 13/WS/0240). A Trial Management Group meets on a monthly basis. Results will be published in peer-reviewed journals, presented at international meetings and disseminated to patient groups. TRIAL REGISTRATION NUMBER ISRCTN10079972, Pre-results.
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Affiliation(s)
- Selina Tsim
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | | | | | | | - Rosie Woodward
- Glasgow Clinical Research Imaging Facility, Queen Elizabeth University Hospital, Glasgow, UK
| | - John E Foster
- Glasgow Clinical Research Imaging Facility, Queen Elizabeth University Hospital, Glasgow, UK
| | - David B Stobo
- Department of Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jim Paul
- Cancer Research UK Glasgow Clinical Trials Unit, UK
| | - Nick A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Anthony Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Kevin G Blyth
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Infection, Immunology and Inflammation, University of Glasgow, Glasgow, UK
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Nowak AK, Chansky K, Rice DC, Pass HI, Kindler HL, Shemanski L, Billé A, Rintoul RC, Batirel HF, Thomas CF, Friedberg J, Cedres S, de Perrot M, Rusch VW, Rami-Porta R, Asamura H, Ball D, Beer D, Beyruti R, Bolejack V, Chansky K, Crowley J, Detterbeck F, Eberhardt WEE, Edwards J, Galateau-Sallé F, Giroux D, Gleeson F, Groome P, Huang J, Kennedy C, Kim J, Kim YT, Kingsbury L, Kondo H, Krasnik M, Kubota K, Lerut A, Lyons G, Marino M, Marom EM, van Meerbeeck J, Mitchell A, Nakano T, Nicholson AG, Nowak A, Peake M, Rice T, Rosenzweig K, Ruffini E, Rusch V, Saijo N, Van Schil P, Sculier JP, Shemanski L, Stratton K, Suzuki K, Tachimori Y, Thomas CF, Travis W, Tsao MS, Turrisi A, Vansteenkiste J, Watanabe H, Wu YL, Baas P, Erasmus J, Hasegawa S, Inai K, Kernstine K, Kindler H, Krug L, Nackaerts K, Pass H, Rice D, Falkson C, Filosso PL, Giaccone G, Kondo K, Lucchi M, Okumura M, Blackstone E, Asamura H, Batirel H, Bille A, Pastorino U, Call S, Cangir A, Cedres S, Friedberg J, Galateau-Salle F, Hasagawa S, Kernstine K, Kindler H, McCaughan B, Nakano T, Nowak A, Ozturk CA, Pass H, de Perrot M, Rea F, Rice D, Rintoul R, Ruffini E, Rusch V, Spaggiari L, Galetta D, Syrigos K, Thomas C, van Meerbeeck J, Nafteux P, Vansteenkiste J, Weder W, Optiz I, Yoshimura M. The IASLC Mesothelioma Staging Project: Proposals for Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Pleural Mesothelioma. J Thorac Oncol 2016; 11:2089-2099. [PMID: 27687963 DOI: 10.1016/j.jtho.2016.08.147] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The current T component for malignant pleural mesothelioma (MPM) has been predominantly informed by surgical data sets and consensus. The International Association for the Study of Lung Cancer undertook revision of the seventh edition of the staging system for MPM with the goal of developing recommendations for the eighth edition. METHODS Data elements including detailed T descriptors were developed by consensus. Tumor thickness at three pleural levels was also recorded. An electronic data capture system was established to facilitate data submission. RESULTS A total of 3519 cases were submitted to the database. Of those eligible for T-component analysis, 509 cases had only clinical staging, 836 cases had only surgical staging, and 642 cases had both available. Survival was examined for T categories according to the current seventh edition staging system. There was clear separation between all clinically staged categories except T1a versus T1b (hazard ratio = 0.99, p = 0.95) and T3 versus T4 (hazard ratio = 1.22, p = 0.09), although the numbers of T4 cases were small. Pathological staging failed to demonstrate a survival difference between adjacent categories with the exception of T3 versus T4. Performance improved with collapse of T1a and T1b into a single T1 category; no current descriptors were shifted or eliminated. Tumor thickness and nodular or rindlike morphology were significantly associated with survival. CONCLUSIONS A recommendation to collapse both clinical and pathological T1a and T1b into a T1 classification will be made for the eighth edition staging system. Simple measurement of pleural thickness has prognostic significance and should be examined further with a view to incorporation into future staging.
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Affiliation(s)
- Anna K Nowak
- National Centre for Asbestos Related Diseases, School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
| | - Kari Chansky
- Cancer Research And Biostatistics, Seattle, Washington
| | | | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York
| | - Hedy L Kindler
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | | | - Andrea Billé
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Robert C Rintoul
- Department of Thoracic Oncology, Papworth Hospital National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Hasan F Batirel
- Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Charles F Thomas
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joseph Friedberg
- Department of Thoracic Surgery, University of Maryland Cancer Center, Baltimore, Maryland
| | - Susana Cedres
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Valerie W Rusch
- Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Armato SG, Blyth KG, Keating JJ, Katz S, Tsim S, Coolen J, Gudmundsson E, Opitz I, Nowak AK. Imaging in pleural mesothelioma: A review of the 13th International Conference of the International Mesothelioma Interest Group. Lung Cancer 2016; 101:48-58. [PMID: 27794408 DOI: 10.1016/j.lungcan.2016.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/05/2016] [Indexed: 12/17/2022]
Abstract
Imaging plays an important role in the detection, diagnosis, staging, response assessment, and surveillance of malignant pleural mesothelioma. The etiology, biology, and growth pattern of mesothelioma present unique challenges for each modality used to capture various aspects of this disease. Clinical implementation of imaging techniques and information derived from images continue to evolve based on active research in this field worldwide. This paper summarizes the imaging-based research presented orally at the 2016 International Conference of the International Mesothelioma Interest Group (iMig) in Birmingham, United Kingdom, held May 1-4, 2016. Presented topics included intraoperative near-infrared imaging of mesothelioma to aid the assessment of resection completeness, an evaluation of tumor enhancement improvement with increased time delay between contrast injection and image acquisition in standard clinical magnetic resonance imaging (MRI) scans, the potential of early contrast enhancement analysis to provide MRI with a role in mesothelioma detection, the differentiation of short- and long-term survivors based on MRI tumor volume and histogram analysis, the response-assessment potential of hemodynamic parameters derived from dynamic contrast-enhanced computed tomography (DCE-CT) scans, the correlation of CT-based tumor volume with post-surgical tumor specimen weight, and consideration of the need to update the mesothelioma tumor response assessment paradigm.
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Affiliation(s)
- Samuel G Armato
- Department of Radiology, The University of Chicago, Chicago, Illinois, USA.
| | - Kevin G Blyth
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK and Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Jane J Keating
- Department of Surgery, University of Pennsylvania Perelman School of Medicine and Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA; Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania Pearlman School of Medicine, Philadelphia, PA, USA
| | - Sharyn Katz
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Selina Tsim
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK and Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Johan Coolen
- Department of Radiology, University Hospitals Leuven, Belgium
| | | | - Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Anna K Nowak
- School of Medicine and Pharmacology and National Centre for Asbestos Related Diseases, University of Western Australia, Perth, Western Australia and Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Rusch VW, Gill R, Mitchell A, Naidich D, Rice DC, Pass HI, Kindler HL, De Perrot M, Friedberg J. A Multicenter Study of Volumetric Computed Tomography for Staging Malignant Pleural Mesothelioma. Ann Thorac Surg 2016; 102:1059-66. [PMID: 27596916 DOI: 10.1016/j.athoracsur.2016.06.069] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/20/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Standard imaging modalities are inaccurate in staging malignant pleural mesothelioma (MPM). Single-institution studies suggest that volumetric computed tomography (CT) is more accurate but labor intensive. We established a multicenter network to test interobserver variability, accuracy (relative to pathologic stage), and the prognostic significance of semiautomated volumetric CT. METHODS Six institutions electronically submitted to an established multicenter database clinical and pathologic data for patients with MPM who had operations. Institutional radiologists reviewed preoperative CT scans for quality and then submitted by electronic network (AG Mednet, www.agmednet.com) to the biostatistical center. Two reference radiologists blinded to clinical data performed semiautomated tumor volume calculations using Vitrea Enterprise 6.0 software (Vital Images, Minnetonka, MN) and then submitted readings to the biostatistical center. Study end points included feasibility of the network, interobserver variability for volumetric CT, correlation of tumor volume to pTN stages, and overall survival (OS). RESULTS Of 164 patients, the CT scans for 129 were analyzable and read by reference radiologists. Most tumors were less than 500 cm(3). A small bias was observed between readers because one provided consistently larger measurements than the other (mean difference, 47.9; p = .0027), but for 80%, the absolute difference was 200 cm(3) or less. Spearman correlation between readers was 0.822. Volume correlated with pTN stages and OS, best defined by three groups with average volumes of 91.2, 245.3, and 511.3 cm(3) associated with median OS of 37, 18, and 8 months, respectively. CONCLUSIONS For the first time, a multicenter network was established and initial correlations of tumor volume with pTN stages and OS are shown. A larger multicenter international study is planned to confirm the results and refine correlations.
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Affiliation(s)
- Valerie W Rusch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Ritu Gill
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alan Mitchell
- Cancer Research and Biostatistics, Seattle, Washington
| | - David Naidich
- Department of Radiology, New York University School of Medicine, New York, New York
| | - David C Rice
- Department of Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Harvey I Pass
- Department of Surgery, New York University School of Medicine and Comprehensive Cancer Center, New York, New York
| | - Hedy L Kindler
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Marc De Perrot
- Department of Surgery, Toronto General Hospital and Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Joseph Friedberg
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Circulating activin A is a novel prognostic biomarker in malignant pleural mesothelioma – A multi-institutional study. Eur J Cancer 2016; 63:64-73. [DOI: 10.1016/j.ejca.2016.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/19/2016] [Indexed: 12/28/2022]
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Novello S, Pinto C, Torri V, Porcu L, Di Maio M, Tiseo M, Ceresoli G, Magnani C, Silvestri S, Veltri A, Papotti M, Rossi G, Ricardi U, Trodella L, Rea F, Facciolo F, Granieri A, Zagonel V, Scagliotti G. The Third Italian Consensus Conference for Malignant Pleural Mesothelioma: State of the art and recommendations. Crit Rev Oncol Hematol 2016; 104:9-20. [PMID: 27286698 DOI: 10.1016/j.critrevonc.2016.05.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/17/2016] [Accepted: 05/10/2016] [Indexed: 11/26/2022] Open
Abstract
Malignant Pleural Mesothelioma (MPM) remains a relevant public health issue, and asbestos exposure is the most relevant risk factor. The incidence has considerably and constantly increased over the past two decades in the industrialized countries and is expected to peak in 2020-2025. In Italy, a standardized-rate incidence in 2011 among men was 3.5 and 1.25 per 100,000 in men and women, respectively, and wide differences are noted among different geographic areas. The disease remains challenging in terms of diagnosis, staging and treatment and an optimal strategy has not yet been clearly defined. The Third Italian Multidisciplinary Consensus Conference on Malignant Pleural Mesothelioma was held in Bari (Italy) in January 30-31, 2015. This Consensus has provided updated recommendations on the MPM management for health institutions, clinicians and patients.
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Affiliation(s)
- S Novello
- Department of Oncology, University of Turin, Italy.
| | - C Pinto
- Medical Oncology Unit, IRCCS-Arciospedale Santa Maria Nuova, Reggio Emilia, Italy
| | - V Torri
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - L Porcu
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, Italy
| | - M Tiseo
- Division of Medical Oncology, Azienda Ospedaliera Universitaria di Parma, Italy
| | - G Ceresoli
- Thoracic Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy
| | - C Magnani
- Cancer Epidemiology, University of Eastern Piedmont and CPO-Piemonte, Novara, Italy
| | - S Silvestri
- Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy
| | - A Veltri
- Department of Oncology, University of Turin, Italy
| | - M Papotti
- Department of Oncology, University of Turin, Italy
| | - G Rossi
- Ospedale Policlinico, Division of Human Pathology, Modena, Italy
| | - U Ricardi
- Department of Oncology, University of Turin, Italy
| | - L Trodella
- Department of Radiotherapy, Campus Bio-Medico University, Rome, Italy
| | - F Rea
- Azienda Ospedaliera, Division of Thoracic Surgery, Padua, Italy
| | - F Facciolo
- Regina Elena Cancer Institute, Division of Thoracic Surgery, Rome, Italy
| | - A Granieri
- University of Torino, Department of Psychology, Italy
| | - V Zagonel
- Veneto Oncology Institute, IRCCS Padova, Italy
| | - G Scagliotti
- Department of Oncology, University of Turin, Italy
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Takenaka T, Yamazaki K, Miura N, Mori R, Takeo S. The Prognostic Impact of Tumor Volume in Patients with Clinical Stage IA Non-Small Cell Lung Cancer. J Thorac Oncol 2016; 11:1074-80. [PMID: 26899756 DOI: 10.1016/j.jtho.2016.02.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 02/05/2016] [Accepted: 02/06/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Tumor volume promises to be an important factor for predicting the prognosis of patients with non-small cell lung cancer (NSCLC). METHODS A total of 255 patients who underwent curative surgical resection for clinical stage IA NSCLC were included. We performed semiautomated measurement of the whole tumor volume and the volume of the solid part (referred to as the solid part volume) from a volumetric analysis of chest three-dimensional computed tomography scans using the SYNAPSE VINCENT imaging software program (Fujifilm Medical, Tokyo, Japan). We evaluated the relationships among tumor size, tumor volume, and survival. RESULTS The mean whole tumor size, the ratio of the maximum diameter of consolidation to the maximum tumor diameter (CTR), the whole tumor volume, and the solid part volume were 20 mm (range 0-30 mm), 0.84 (range 0-1.0), 3080 mm(3) (range 123-17509 mm(3)), and 2032 mm(3) (0-12466 mm(3)), respectively. The receiver operating characteristic area under the curve for the whole tumor size, CTR, whole tumor volume, and solid part volume used to identify recurrence were 0.60, 0.68, 0.58, and 0.69, respectively. A univariate analysis revealed that the whole tumor size, CTR, whole tumor volume, and solid part volume were associated with disease-free survival (DFS). A multivariate analysis of these factors identified the solid part volume to be the only independent factor for the prediction of DFS. CONCLUSIONS The whole tumor volume and the solid part volume were associated with DFS. In particular, the solid part volume was a very useful factor for predicting prognosis in clinical stage IA NSCLC.
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Affiliation(s)
- Tomoyoshi Takenaka
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
| | - Koji Yamazaki
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Naoko Miura
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Ryo Mori
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Sadanori Takeo
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
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