Malignant Mesothelioma
Stages of malignant mesothelioma
Patients with stage I have a significantly better prognosis than those with more advanced stages. Given the relative rarity of this disease, based on accurate information being survival is limited. A proposed staging system is based on principles and thoracic surgery clinical data are shown below.
This is a change to the system proposed by Butchart et al elderly. Stadiums Other systems have been used, including the current system of international TNM staging are summarized by the International Mesothelioma Interest Group.
* Stage I: disease confined within the capsule of the parietal pleura (ie, ipsilateral pleura, lung, pericardium and diaphragm).
* Phase II: All of stage I with positive intrathoracic (N1 and N2) lymph nodes
.
* Stage III: local extension of disease to the following areas, for example, the chest wall or mediastinum, heart, or through the diaphragm or peritoneum, with or without extrathoracic or contralateral (N3) lymph node involvement
.
* Stage IV: Metastatic disease outside.
For the purposes of the debate on the treatment in this summary, the disease is classified as localized or advanced.
Localized malignant mesothelioma:
The first phase I.
Advanced malignant mesothelioma:
The II, III and IV phases.
Standard treatment options:
1. Solitary mesothelioma:
A surgical en bloc resection, including the structures to ensure continuous disease without wide margins. Sessile polypoid lesions have a treatment with surgical resection to ensure maximum potential for healing.
2. Intracavitary mesothelioma:
* Palliative surgery (ie decortication and pleurectomy), with or without postoperative radiotherapy.
* Extrapleural pneumonectomy.
* Palliative radiotherapy.
Advanced malignant mesothelioma
Standard treatment options:
1. Symptomatic treatment includes drainage of effusions, chest tube pleurodesis, or thoracoscopic pleurodesis. (see bulletin PDQ on Cardiopulmonary Syndromes for more information.)
2. Palliative surgical resection selected patients.
3. Palliative radiotherapy.
4. Single agent chemotherapy. Answers pieces already on with doxorubicin, epirubicin, mitomycin, cyclophosphamide, cisplatin, carboplatin and ifosfamide.
5. Combination chemotherapy (by clinical assessment). Information about ongoing clinical trials established nic site.
6. Multimodality clinic.
7. Intracavitary treatment. Administration intrapleural or intraperitoneal chemotherapy (eg cisplatin, mitomycin and cytarabine) has been reported to produce a transient reduction of the size of the temporary increase Hhmonim and control of spills of small clinical studies. Additional studies are needed to define the role of intracavitary therapy.
Many of the second phase of chemotherapy trials have condemn. the safety and efficacy of pemetrexed, the antifolate, and cisplatin chemotherapy, in patients with malignant mesothelioma naive that were not eligible for curative surgery was demonstrated in a randomized phase III trial.
Evidence Level :
This trial compared pemetrexed (500 mg/m2) and cisplatin (75 mg/m2 day 1) with only cisplatin (75 mg/m2 day 1 intravenously every 21 days). With a total of 456 patients registered for the trial, 226 patients received pemetrexed plus cisplatin, 222 patients received cisplatin alone, and 8 patients received no treatment. After 117 patients were registered, folic acid and vitamin B12 were added to reduce their toxic effects.
Folic acid (350-1,000 mg here) was administered daily from 1 to 3 weeks before the first dose chemotherapy and continuing until the day 1 to 3 weeks after treatment ended. A vitamin B12 injection (1000 mg intramuscularly) was administered 1 to 3 weeks before the first dose chemotherapy, and repeated approximately every 9 weeks until the treatment has ended.
Dexamethasone (4 mg) or equivalent corticosteroid was administered twice a day here for rash prophylaxis to all patients 1 day before, day and 1 day after each pemetrexed dose.
The analysis of all patients who were randomized and treated, the combination of cisplatin and pemetrexed was associated with statistically significant improvement in survival compared with cisplatin isolation, the mean survival was 12.1 versus 9.3 months, respectively (P = .020).
Hazard ratio of death of patients on pemetrexed and cisplatin arm compared with the control arm was 0.77. Average time of progression was more significant that pemetrexed and cisplatin arm (5.7 months versus 3.9 months, P = .001).
The advantage of the combination of arms was also shown the vitamin-supplemented subgroup. The Middle of survival were 13.3 and 10.0 months in the combination of cisplatin alone group, respectively (P = .051).
The main negative effects of pemetrexed plus cisplatin regime were myelosuppression, fatigue, nausea, and shortness of breath. Most of grade 3 and 4 were significantly reduce the negative effects of vitamin supplementation does not decrease the efficiency.
Patients with stage I have a significantly better prognosis than those with more advanced stages. Given the relative rarity of this disease, based on accurate information being survival is limited. A proposed staging system is based on principles and thoracic surgery clinical data are shown below.
This is a change to the system proposed by Butchart et al elderly. Stadiums Other systems have been used, including the current system of international TNM staging are summarized by the International Mesothelioma Interest Group.
* Stage I: disease confined within the capsule of the parietal pleura (ie, ipsilateral pleura, lung, pericardium and diaphragm).
* Phase II: All of stage I with positive intrathoracic (N1 and N2) lymph nodes
.
* Stage III: local extension of disease to the following areas, for example, the chest wall or mediastinum, heart, or through the diaphragm or peritoneum, with or without extrathoracic or contralateral (N3) lymph node involvement
.
* Stage IV: Metastatic disease outside.
For the purposes of the debate on the treatment in this summary, the disease is classified as localized or advanced.
Localized malignant mesothelioma:
The first phase I.
Advanced malignant mesothelioma:
The II, III and IV phases.
Localized Malignant Mesothelioma:
Standard treatment options:
1. Solitary mesothelioma:A surgical en bloc resection, including the structures to ensure continuous disease without wide margins. Sessile polypoid lesions have a treatment with surgical resection to ensure maximum potential for healing.
2. Intracavitary mesothelioma:
* Palliative surgery (ie decortication and pleurectomy), with or without postoperative radiotherapy.
* Extrapleural pneumonectomy.
* Palliative radiotherapy.
Advanced malignant mesothelioma
Standard treatment options:
1. Symptomatic treatment includes drainage of effusions, chest tube pleurodesis, or thoracoscopic pleurodesis. (see bulletin PDQ on Cardiopulmonary Syndromes for more information.)
2. Palliative surgical resection selected patients.
3. Palliative radiotherapy.
4. Single agent chemotherapy. Answers pieces already on with doxorubicin, epirubicin, mitomycin, cyclophosphamide, cisplatin, carboplatin and ifosfamide.
5. Combination chemotherapy (by clinical assessment). Information about ongoing clinical trials established nic site.
6. Multimodality clinic.
7. Intracavitary treatment. Administration intrapleural or intraperitoneal chemotherapy (eg cisplatin, mitomycin and cytarabine) has been reported to produce a transient reduction of the size of the temporary increase Hhmonim and control of spills of small clinical studies. Additional studies are needed to define the role of intracavitary therapy.
Many of the second phase of chemotherapy trials have condemn. the safety and efficacy of pemetrexed, the antifolate, and cisplatin chemotherapy, in patients with malignant mesothelioma naive that were not eligible for curative surgery was demonstrated in a randomized phase III trial.
Evidence Level :
This trial compared pemetrexed (500 mg/m2) and cisplatin (75 mg/m2 day 1) with only cisplatin (75 mg/m2 day 1 intravenously every 21 days). With a total of 456 patients registered for the trial, 226 patients received pemetrexed plus cisplatin, 222 patients received cisplatin alone, and 8 patients received no treatment. After 117 patients were registered, folic acid and vitamin B12 were added to reduce their toxic effects.
Folic acid (350-1,000 mg here) was administered daily from 1 to 3 weeks before the first dose chemotherapy and continuing until the day 1 to 3 weeks after treatment ended. A vitamin B12 injection (1000 mg intramuscularly) was administered 1 to 3 weeks before the first dose chemotherapy, and repeated approximately every 9 weeks until the treatment has ended.
Dexamethasone (4 mg) or equivalent corticosteroid was administered twice a day here for rash prophylaxis to all patients 1 day before, day and 1 day after each pemetrexed dose.
The analysis of all patients who were randomized and treated, the combination of cisplatin and pemetrexed was associated with statistically significant improvement in survival compared with cisplatin isolation, the mean survival was 12.1 versus 9.3 months, respectively (P = .020).
Hazard ratio of death of patients on pemetrexed and cisplatin arm compared with the control arm was 0.77. Average time of progression was more significant that pemetrexed and cisplatin arm (5.7 months versus 3.9 months, P = .001).
The advantage of the combination of arms was also shown the vitamin-supplemented subgroup. The Middle of survival were 13.3 and 10.0 months in the combination of cisplatin alone group, respectively (P = .051).
The main negative effects of pemetrexed plus cisplatin regime were myelosuppression, fatigue, nausea, and shortness of breath. Most of grade 3 and 4 were significantly reduce the negative effects of vitamin supplementation does not decrease the efficiency.
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