Journal of Surgical Oncology

Our medical research library holds 37 studies published in Journal of Surgical Oncology (1979–2023). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 35 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it. For 1 study PubMed has no abstract for, we give the abstract printed in the article or, where there is none, a summary we wrote from it, each labeled as such.

About the journal

• Publisher: Wiley-Liss
• Published: 1969 to the present, United States
• Language: English
• ISSN: 0022-4790 (print), 1096-9098 (electronic)
• Absorbed: Seminars in Surgical Oncology
• Its record in the NLM Catalog

2020s

• Contemporary issues in the surgical management of pleural mesothelioma. J. Paajanen, M.T. Jaklitsch, R. Bueno. 2023;127(2):343-354. Review PubMed · Publisher · Free full text

  Abstract

  The surgical management of pleural mesothelioma (PM) can be divided into diagnostic, staging, palliation, and cytoreductive surgery. In the cytoreductive surgical setting, the combination of different treatment modalities has led to better outcomes than surgery alone. The scarcity of high-quality studies has led to heterogeneity in management of PM across the mesothelioma treatment centers. Here, we review the literature regarding the most important open questions and ongoing clinical trials.

  © 2022 Wiley Periodicals LLC.

• High-dose IV magnesium in mesothelioma patients receiving surgery with hyperthermic intraoperative cisplatin: Pilot studies and design of a phase II randomized clinical trial. S. Gupta, S.L. Wells, A.M. Jose, et al. 2023;128(7):1141-1149. PubMed · Publisher · Free full text

  Abstract

  Introduction: Hyperthermic intraoperative cisplatin (HIOC) is associated with acute kidney injury (AKI). Administration of high-dose magnesium attenuates cisplatin-induced AKI (CP-AKI) in animal models but has not been rigorously examined in humans.

  Methods: We tested the feasibility and safety of different doses of magnesium in mesothelioma patients receiving HIOC. In Pilot Study 1, we administered a 36-h continuous infusion of magnesium at 0.5 g/h, targeting serum magnesium levels between 3 and 4.8 mg/dL. In Pilot Study 2A, we administered a 6 g bolus followed by an infusion starting at 2 g/h, titrated to achieve levels between 4 and 6 mg/dL. We eliminated the bolus in Pilot Study 2B.

  Results: In Pilot Study 1, all five patients enrolled completed the study; however, median postoperative Mg levels were only 2.4 mg/dL. In Pilot Study 2A, two of four patients (50%) were withdrawn due to bradycardia during the bolus. In Pilot Study 2B, two patients completed the study whereas two developed postoperative bradycardia attributed to the magnesium.

  Conclusions: A 0.5 g/h infusion for 36 h did not achieve therapeutic magnesium levels, while an infusion at 2 g/h was associated with bradycardia. These studies informed the design of a randomized clinical trial testing whether intravenously Mg attenuates HIOC-associated AKI.

  © 2023 Wiley Periodicals LLC.

• Malignant pleural mesothelioma characteristics and outcomes: A SEER-Medicare analysis. E. Taioli, A. Wolf, N. Alpert, et al. 2023;128(1):134-141. PubMed · Publisher

  Abstract

  Background: Pleural mesothelioma is rare cancer linked to asbestos exposure. Previous research has indicated that female individuals have better survival than male individuals, but this has never been examined in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database.

  Materials And Methods: Malignant pleural mesothelioma cases diagnosed from 1992 to 2015 were queried from the linked SEER-Medicare database. Multivariable logistic regression was used to assess the clinical and demographic factors associated with sex. A multivariable Cox proportional hazards model and propensity matching methods were used to assess sex differences in overall survival (OS) while accounting for potential confounders.

  Results: Among 4201 patients included in the analysis, 3340 (79.5%) were males and 861 (20.5%) females. Females were significantly older, with more epithelial histology than males were, and had significantly better OS, adjusted for confounders (adjusted hazard ratio, 0.83, 95% confidence interval: 0.76-0.90). Other variables independently associated with improved survival included younger age at diagnosis, having a spouse/domestic partner, epithelial histology, lower comorbidity score, and receipt of surgery or chemotherapy.

  Conclusions: The study describes sex differences in mesothelioma occurrence, treatment, and survival and is the first to examine SEER-Medicare. It provides directions for future research into potential therapeutic targets.

  © 2023 Wiley Periodicals LLC.

2010s

• Adequate nephroprotection reduces renal complications after hyperthermic intrathoracic chemotherapy. T. Markowiak, N. Kerner, R. Neu, et al. 2019;120(7):1220-1226. PubMed · Publisher

  Abstract

  Background And Objectives: Hyperthermic intrathoracic chemotherapy (HITOC) is used for the treatment of malignant pleural tumors. Although HITOC proved to be safe, postoperative renal failure due to nephrotoxicity of intrapleural cisplatin remains a concern.

  Methods: This single-center study was performed retrospectively in patients who underwent pleural tumor resection and HITOC between September 2008 and December 2018.

  Results: A total of 84 patients (female n = 33; 39.3%) with malignant pleural tumors underwent surgical cytoreduction with subsequent HITOC (60 minutes; 42°C). During the study period, we gradually increased the dosage of cisplatin (100-150 mg/m2 BSA n = 36; 175 mg/m2 BSA n = 2) and finally added doxorubicin (cisplatin 175 mg/m2 BSA/doxorubicin 65 mg; n = 46). All patients had perioperative fluid balancing. The last 54 (64.3%) patients also received perioperative cytoprotection. Overall 29 patients (34.5%) experienced renal insufficiency. Despite higher cisplatin concentrations, patients with cytoprotection showed significantly lower postoperative serum creatinine levels after 1 week (P = .006) and at discharge (P = .020). Also, they showed less intermediate and severe renal insufficiencies (5.6% vs 13.3%).

  Conclusions: Adequate perioperative fluid management and cytoprotection seem to be effective in protecting renal function. This allows the administration of higher intracavitary cisplatin doses without raising the rate of renal insufficiencies.

  © 2019 Wiley Periodicals, Inc.

• Long-term survival outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy: Single-institutional experience with 1225 cases. L.S. Kyang, N.A. Alzahrani, S.J. Valle, et al. 2019;120(4):794-802. PubMed · Publisher

  Abstract

  Background And Objectives: To review long-term survival outcomes of patients with Peritoneal metastasis (PM) who underwent colorectal cancer (CRS) and intraperitoneal chemotherapy (PIC).

  Methods: Patients that underwent CRS, with or without PIC, from January 1996 to March 2018 at the Peritonectomy Unit of St. George Hospital, Sydney were retrospectively analyzed from a prospectively maintained database.

  Results: The study comprised of 1225 cases, including 687 females (56.1%) and 538 males (43.9%). Diagnoses included CRC (n = 363), followed by HAMN (n = 317), LAMN (n = 297), mesothelioma (n = 101), ovarian cancer (n = 55), and others including gastric, sarcoma, and neuroendocrine tumor (n = 92). The median OS, 5- and 10-year survivals for CRC were 35 months, 33% and 8%, respectively. Patients with LAMN, in relative to HAMN, experienced a higher median OS, 5- and 10-year survivals (248 months vs 63 months; 82% vs 52% and 59% vs 28%). The median OS for mesothelioma was 60 months with 5- and 10-year survivals of 48% and 19%, respectively. In ovarian cancer, the median OS was 30 months with 5- and 10-year survivals of 26% and 10%, respectively. For the remaining histological diagnoses, median OS and 5-year survival were 28 months and 27%, respectively.

  Conclusion: Our large-cohort data showed that CRS/PIC can provide long-term survival benefit to patients with PM of gastrointestinal and ovarian origin.

  © 2019 Wiley Periodicals, Inc.

• Elevated brain natriuretic peptide (BNP) is an early marker for patients at risk for complications after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC). S.B. Fisher, S. Rafeeq, K. Hess, et al. 2018;117(4):685-691. PubMed · Publisher

  Abstract

  Background: Elevated BNP is associated with adverse cardiac outcomes after noncardiac surgery. We assessed BNP values as markers of perioperative fluid status and their correlation with major/cardiopulmonary (CP) complications following CRS + HIPEC.

  Methods: Fluid balance, BNP levels, and morbidity data were collected for all patients undergoing CRS + HIPEC between 6/2014 and 2/2016.

  Results: One hundred and twenty-nine patients underwent CRS + HIPEC for appendiceal adenocarcinoma (n = 99), mesothelioma (n = 16), and colon cancer (n = 14). Less than 10% had CP comorbidities. The median PCI was 14 (range 4-39); 89% underwent CC0/1 resection (n = 115). Median blood loss (EBL) was 497 mL (50-2700). Major complications (Clavien III-V) occurred in 16 (12%), CP in 17 (13%), and major/CP in 24 (18%). Thirty-day mortality occurred in 2 (1.5%). Elevated BNP on POD1 correlated with increased risk of major/CP complications (OR 2.2, P = 0.052). This was most pronounced in the 25 patients receiving cisplatin: for each 100 unit increase in POD1 BNP the OR for major/CP complication was 7.4 versus 1.2 for the remaining patients, P = 0.083. Multivariate analysis identified increased EBL (OR 4.1 P = 0.011) and a trend toward increased BNP on POD1 (OR for each 100 unit increase 2.0, P = 0.10) as risk factors for major/CP complications.

  Conclusions: Postoperative BNP measurement after CRS + HIPEC may guide postoperative fluid resuscitation and facilitate identification of patients at risk for major and/or cardiopulmonary complications.

  © 2017 Wiley Periodicals, Inc.

• Intraoperative fluorescence imaging in thoracic surgery. A.D. Newton, J.D. Predina, S. Nie, et al. 2018;118(2):344-355. Review PubMed · Publisher · Free full text

  Abstract

  Intraoperative fluorescence imaging (IFI) can improve real-time identification of cancer cells during an operation. Phase I clinical trials in thoracic surgery have demonstrated that IFI with second window indocyanine green (TumorGlow® ) can identify subcentimeter pulmonary nodules, anterior mediastinal masses, and mesothelioma, while the use of a folate receptor-targeted near-infrared agent, OTL38, can improve the specificity for diagnosing tumors with folate receptor expression. Here, we review the existing preclinical and clinical data on IFI in thoracic surgery.

  © 2018 Wiley Periodicals, Inc.

• Short-term outcomes of pleurectomy decortication and extrapleural pneumonectomy in mesothelioma. M. van Gerwen, A. Wolf, B. Liu, et al. 2018;118(7):1178-1187. Meta-analysis · Review PubMed · Publisher

  Abstract

  Background/Objectives: We evaluated postoperative mortality and complications after extrapleural pneumonectomy (EPP) and pleurectomy decortication (P/D) to better understand their effectiveness in malignant pleural mesothelioma (MPM).

  Methods: A meta-analysis was done to evaluate 30-day mortality and postoperative complications. In addition, in-patients data of 500 eligible patients with MPM who underwent EPP or P/D was extracted from the New York Statewide Planning and Research Cooperative System (SPARCS). Multivariate analyses and propensity matching were used to compare in-hospital mortality and postoperative complications in EPP vs P/D.

  Results: The meta-analysis showed a statistically significant difference in 30-day mortality (5% [95% CI: 4-6] vs P/D 2% [95% CI: 1-3]), proportion of complications (46% [95% CI: 36-56] vs 24% [95% CI: 15-34]) and postoperative arrhythmias (20% [95% CI: 12-31] vs 5% [95% CI: 2-8]) for EPP vs P/D. In-hospital mortality (OR adj : 2.6; 95% CI: 0.86-7.75) and postoperative complications (OR adj : 1.1; 95% CI: 0.68-1.86) were not different in EPP compared with P/D while supraventricular arrhythmia was significantly more frequent after EPP vs P/D (OR adj : 5.2; 95% CI: 2.34-11.33).

  Conclusions: Postoperative mortality, postoperative complications, and particularly supraventricular arrhythmia are less frequent after P/D vs EPP. P/D, a less invasive surgery, may provide a better option when technically feasible for patients with MPM.

  © 2018 Wiley Periodicals, Inc.

• Interval between cytoreductions as a marker of tumor biology in selecting patients for repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. I.T. Konstantinidis, E.A. Levine, K. Chouliaras, et al. 2017;116(6):741-745. PubMed · Publisher · Free full text

  Abstract

  Background And Objectives: Repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for recurrence of peritoneal surface malignancies is safe and effective. Patient selection and factors associated with a favorable outcome are still evolving.

  Methods: A prospectively maintained institutional database consisting of 1314 CRS/HIPEC procedures performed between February 1993 and December 2015 was reviewed. Clinicopathologic data from 103 patients and 112 (8.5%) repeat CRS/HIPEC procedures were retrospectively analyzed.

  Results: Primary tumors were appendiceal for 60 patients (58.3%), mesothelioma for 14 (13.6%), colorectal for 9 (8.7%), ovarian for 8 (7.8%). R0/R1 resection was achieved in 46 (46.5%) patients. The time interval between the initial and the repeat CRS/HIPEC was <1 year for 21 (20.4%), 1-2 years for 40 (38.8%), and >2 years for 42 patients (40.8%). Overall median survival was 4.3 years and correlated with the time interval (1.3 years for <1 years, 3.7 years for 1-2 years, and 7 years for >2 years; P < 0.001). In multivariate analysis, the R status (P = 0.005) and a time interval of more than 2 years (P = 0.0002) were strongly associated with survival with each additional month between the surgeries conferring a 2.6% reduction in the risk of death.

  Conclusions: The current series validates time interval between cytoreductions as a major surrogate of tumor biology in selection of patients with recurrent peritoneal surface malignancies for repeat CRS/HIPEC. Complete repeat cytoreduction more than 2 years from the initial surgery is associated with a favorable outcome.

  © 2017 Wiley Periodicals, Inc.

• What made hyperthermic intraperitoneal chemotherapy an effective curative treatment for peritoneal surface malignancy: A 25-year experience with 1,125 procedures. G. Passot, D. Vaudoyer, L. Villeneuve, et al. 2016;113(7):796-803. PubMed · Publisher

  Abstract

  Objective: To review our 25-year experience with hyperthermic intra-peritoneal chemotherapy (HIPEC).

  Background: Combining cytoreductive surgery (CRS) and HIPEC as local treatments for peritoneal carcinomatosis (PC) was proposed 25 years ago.

  Methods: A prospective database of all patients undergoing HIPEC for PC since 1989 was searched for clinicopathological data, 90-day morbidity and mortality, and survival.

  Results: Among 1,125 HIPEC procedures, PC origin was colorectal (342; 30%), ovarian (271; 24%), pseudomyxoma peritonei (189; 17%), gastric (127; 11%), malignant mesothelioma (84; 8%), or other (112; 10%). Between 2004-2009 (n = 321) and 2010-2015 (n = 560), the median peritoneal cancer index decreased (11 vs. 8; P < 0.001), fewer patients underwent incomplete cytoreduction (CC2-3: 4% vs. 0.5%; P < 0.001), and more were included in randomized trials (5% vs. 16%; P < 0.001). Postoperative morbidity (52% vs. 50%, P = 0.672) was not different, but mortality significantly decreased (5% vs. 2%; P = 0.030). Median overall-survival was 42 months, and improved significantly for each 5-year period except for 2006-2010 vs. 2011-2015 (P = 0.097). The 10-year survival without recurrence was 53%, 14%, 4%, 10%, and 9% for pseudomyxoma, mesothelioma, ovarian, colorectal, and gastric PC, respectively.

  Conclusion: This study demonstrated that CRS and HIPEC provide long-term survival irrespective of PC origin, and survival improves with experience. J. Surg. Oncol. 2016;113:796-803. © 2016 Wiley Periodicals, Inc.

  © 2016 Wiley Periodicals, Inc.

• Fertility preservation in a patient with benign multicystic peritoneal mesothelioma. Z.A. Al-Safi, B.H. Edil, M.D. Post, et al. 2014;110(4):372-4. Case report PubMed · Publisher

  Abstract

  Benign multicystic peritoneal mesothelioma (BMPM) is a rare peritoneal tumor. Surgery is the only effective treatment for BMPM, and affected tissues occasionally must be sacrificed to achieve adequate debulking. A 25-year-old female was diagnosed with BMPM. She was counseled on fertility preservation and had oocyte cryopreservation prior to her debulking. Fertility preservation through embryo or oocyte cryopreservation is a valuable option for patients at risk of losing reproductive tissues during extensive surgery and chemotherapy.

  © 2014 Wiley Periodicals, Inc.

• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases. T.C. Chua, L.E. Quinn, J. Zhao, et al. 2013;108(2):81-8. PubMed · Publisher

  Abstract

  Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) achieves disease control within the peritoneum but recurrences occur. This study examines the outcomes of iterative CRS (iCRS) HIPEC for treatment of recurrent peritoneal metastases.

  Methods: Patients who underwent iCRS in a single tertiary referral center were identified from a prospective database. Safety analysis was performed and clinicopathological variables were analyzed to assess factors predictive of major morbidity and survival.

  Results: The demographics of patients who underwent primary cytoreductive surgery (pCRS) (n = 466) and iCRS (n = 79) were balanced between groups. pCRS was shown to require more blood transfusion (P = 0.019) and albumin use (P = 0.013). The mortality and major complication rates were comparable (1.2% vs. 0%; P = 0.600, and 42% vs. 41%; P = 0.806). Residual pneumothorax occurred more frequently after pCRS (12% vs. 4%; P = 0.030). Factors associated with major complications after iCRS include use of HIPEC (P = 0.042) and length of hospital stay (P = 0.024). The overall median survival was 48 months and 5-year survival was 34%. By cancer type, the 3-year survival was 0%, 74%, 80%, and 72% for colorectal, appendiceal pseudomyxoma, peritoneal mesothelioma, and appendix cancer, respectively. Independent predictors of survival include age (P = 0.049), interval between pCRS and iCRS (P = 0.008), small bowel resection (P < 0.001), and use of HIPEC (P = 0.005).

  Conclusion: Iterative CRS achieved further peritoneal disease control without adverse effects on morbidity. Patients with appendiceal tumors and peritoneal mesothelioma appear to benefit most after iCRS. Intraoperative HIPEC remains important in the repetoire of managing these patients.

  Copyright © 2013 Wiley Periodicals, Inc.

• Local and systemic exposure of cisplatin during hyperthermic intrathoracic chemotherapy perfusion after pleurectomy and decortication for treatment of pleural malignancies. M. Ried, T. Potzger, N. Braune, et al. 2013;107(7):735-40. PubMed · Publisher

  Abstract

  Background: Assessing the pharmacokinetics of intrapleurally administered cisplatin during hyperthermic intrathoracic chemotherapy perfusion (HITHOC) following pleurectomy/decortication in patients with malignant pleural mesothelioma or advanced thymoma with pleural spread.

  Methods: Pharmacokinetic analysis (ICP-MS) of intrapleural cisplatin with a dosage of 100 mg/m(2) (n = 5) or 150 mg/m(2) (n = 5) at 42°C perfusate temperature. Simultaneous pleural perfusion fluid and serum samples were collected at the beginning and every 15 min. Serum samples were collected at the end of the operation, 6, 12, and 24 hr postoperative.

  Results: Mean cisplatin levels in the perfusate slightly decreased during the HITHOC. The mean area under the curve ratios (AUC perfusate :AUC serum ) of cisplatin were nearly similar. The mean AUCs of cisplatin in the perfusate were approximately 58 and 55 times greater than detected in the serum. The mean peak of cisplatin in the serum was reached after 1 hr of HITHOC. The AUC of cisplatin in the serum did not significantly differ (P = 0.18) between both groups up to 24 hr after perfusion.

  Conclusions: HITHOC with cisplatin provides a pharmacological advantage of high local intrapleural cisplatin concentrations. Elevation of the cisplatin dosage to 150 mg/m(2) did not lead to a significant increase of the systemic cisplatin concentration.

  Copyright © 2013 Wiley Periodicals, Inc.

• Diffuse malignant peritoneal mesothelioma: systematic review of clinical management and biological research. D. Baratti, S. Kusamura, M. Deraco. 2011;103(8):822-31. Systematic review PubMed · Publisher

  Abstract

  Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon and locally aggressive tumor with poor prognosis. Currently, no standard therapy is available. The biology of this disease is still poorly understood. We performed a systematic search of relevant studies on clinical management and biological research of DMPM. Trials were selected using a predetermined protocol. The current evidence suggests that cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC) results in improved survival. Biological understanding of DMPM is currently evolving.

  Copyright © 2011 Wiley-Liss, Inc.

• Epidermal growth factor receptor overexpression in malignant pleural mesothelioma: prognostic correlations. O. Rena, L.R. Boldorini, E. Gaudino, et al. 2011;104(6):701-5. PubMed · Publisher

  Abstract

  Background: To evaluate epidermal growth factor receptor (EGFR) phenotypic expression and related gene status in malignant pleural mesothelioma (MPM) and to correlate the results with patients' prognosis.

  Method: Eighty-three cases of MPM specimens were submitted to immunohistochemical (IHC) staining to evaluate the expression of EGFR protein; positive cases were submitted to fluorescence in situ hybridization (FISH) to investigate the gene status. Results were correlated with clinico-pathological characteristics and long-term survival.

  Results: Thirty-eight cases (46%) demonstrated a positive IHC reaction [30/57 (52%) epithelial and 8/20 (40%) biphasic whereas sarcomatous MPM were negative]. No association was recorded between EGFR IHC positive staining and age, gender, or asbestos exposure. Three out of 38 (8%) cases submitted to FISH were positive revealing gene amplification or polysomy. Mean follow-up was 15.4 months (range 2-44). Epithelial subtype only was confirmed to affect prognosis (2-years survival rate 40 vs. 18% for non-epithelial subtype, P = 0.042). When epithelial MPM patients were considered, IHC EGFR positive staining was demonstrated to be a negative prognostic factor (2-years survival rate 26 vs. 60% for IHC EGFR negative staining; P = 0.026).

  Conclusions: EGFR overexpression is identified by IHC in 52% of epithelial MPM and is demonstrated to be a factor negatively affecting prognosis. Phenotypic overexpression seems not to be related to gene status alteration.

  Copyright © 2011 Wiley Periodicals, Inc.

2000s

• Mesothelioma of the tunica vaginalis testis: a rare malignancy mimicking more common inguino-scrotal masses. P.J. Schure, K.C. van Dalen, H.M. Ruitenberg, et al. 2006;94(2):162-4; discussion 161. Case report PubMed · Publisher

  Abstract

  Malignant pleural mesotheliomas are rare malignancies associated with asbestos exposure and these tumors are infamous for their poor prognosis. Mesotheliomas in other body areas are much rarer. They may occur in the abdominal cavity and also in the inguinal region. In the latter area they are commonly confused with much commoner benign conditions. We present three cases of mesotheliomas in the tunica vaginalis testis.

  Copyright (c) 2006 Wiley-Liss, Inc.

• Malignant peritoneal mesothelioma. K.E. Bani-Hani, K.A. Gharaibeh. 2005;91(1):17-25. PubMed · Publisher

  Abstract

  Background And Objectives: The incidence of malignant peritoneal mesothelioma (MPM) is rising. Our aim was to present our experience with this entity in order to increase the awareness about this disease to avoid misdiagnosis.

  Methods: Records of seven patients with histologically confirmed MPM were retrospectively reviewed. Demographic and clinicopathological findings were studied in detail.

  Results: There were two females and 5 males; mean age was 50.3 years (range 16-73). Asbestos exposure was recorded in two patients, familial Mediterranean fever in one and previous radiation in one. Main presentations were abdominal pain and distension. None of the patients was diagnosed preoperatively. The average delay in diagnosis was 10 months. Calretinin expression was identified in all tumors. Three patients were treated with cytoreductive surgery combined with systemic chemotherapy. Two patients who remain alive were young female patients who were diagnosed by laparoscopic incidental findings and were treated with cytoreductive surgery combined with hyperthermic intraoperative intraperitoneal chemotherapy (HIIC). Median survival was 19.7 months. The average survival time of the five patients who died of their diseases was 10.2 months.

  Conclusions: An awareness of MPM is important to prevent misdiagnosis. Immunohistochemistry has an important role in confirming the diagnosis. MPM remains a difficult therapeutic challenge. Thorough cytoreductive surgery is the cornerstone of current treatment while HIIC is a promising strategy in suitable patients.

• Survival after conservative (palliative) management of pleural malignant mesothelioma. N. Merritt, C.J. Blewett, J.D. Miller, et al. 2001;78(3):171-4. PubMed · Publisher

  Abstract

  Background And Objectives: Malignant mesothelioma is a lethal disease. Aggressive multimodality treatment protocols are reportedly associated with improved survival, but the apparent survival benefits may simply reflect patient selection and the variable natural history of this malignancy. Before embarking on our own protocol of experimental treatment for mesothelioma, we sought to identify important prognostic factors and document the survival of patients treated conservatively (with palliative intent only) in our region.

  Methods: We performed a retrospective review of all patients with a diagnosis of malignant mesothelioma seen at our center between 1987 and 1999. Since curative intent treatment had not been given, we assumed that measured survival would largely reflect the natural history of the malignancy.

  Results: There were 101 patients (80 males and 21 females). Mean age was 65 +/- 9.2 years. Symptoms of disease were present for a median time of 5 months before the diagnosis was established. The most common presenting symptoms were dyspnea (46 patients), chest pain (30 patients), and weight loss (22 patients). Sixty-eight patients (68%) had a history of asbestos exposure. Mesothelioma subtypes included epithelial (43 patients), sarcomatous (26 patients), mixed (19 patients), desmoplastic (4 patients), and unspecified (9 patients). All 101 patients were treated with palliative intent. Talc pleurodesis was performed in 70 patients. At the time of analysis, 90 patients had died and 11 remained alive. Median survival was 213 (95% CI 137-289) days. Survival for the three major histological subtypes was significantly different (log rank, P = 0.0016). Histological subtype (epithelial favorable) was the only significant independent prognostic factor (Cox proportional hazard regression, P = 0.0009).

  Conclusions: Patients with epithelial mesothelioma survive longer than those with other histological subtypes. Conservatively managed patients with pleural malignant mesothelioma have a median survival of approximately 7 months. These data from conservatively treated patients can serve as baseline information for future studies of experimental treatments.

  Copyright 2001 Wiley-Liss, Inc.

• Primary diffuse malignant peritoneal mesothelioma: case report and update of therapy. D. Piazza, F. Caruso, S. Scaringi, et al. 2000;75(1):55-8. Case report PubMed · Publisher

  Abstract

  Background And Objectives: Primary Diffuse Malignant Peritoneal Mesothelioma is a rare disease, with an incidence of 2.2 cases in 1. 000.000 in the USA. It occupies 10% of all mesotheliomas referred in literature.

  Methods: We describe a case of diffuse malignant peritoneal mesothelioma arising in a 54-year-old woman who presented a small bowel occlusion. A middle line laparotomy was done; multiple biopsies and an ileostomy were performed. There was not a history of exposure to asbestos. Histologic diagnosis was based on light microscopy, histochemistry, and immunohistochemistry.

  Results: Patient had no further treatment because of her poor general conditions. She died 4 months later.

  Conclusions: Update of treatment is briefly described with particular attention to multimodality approach (surgery, chemotherapy, radiotherapy) and other new therapeutic options (iperthermochemotherapy, immunotherapy, gene therapy), currently in clinical trials.

  Copyright 2000 Wiley-Liss, Inc.

1990s

• Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma. G.H. Eltabbakh, M.S. Piver, R.E. Hempling, et al. 1999;70(1):6-12. PubMed · Publisher

  Abstract

  Background And Objective: The clinical picture, response to therapy, and prognosis of women with diffuse malignant peritoneal mesotheliomas (DMPM) are ill defined. The purpose of this study is to report on the clinical picture, response to therapy, and survival of women with DMPM.

  Methods: The study is a retrospective review of 15 women with the confirmed pathologic diagnosis of DMPM treated between 1964 and 1996. Survival curves were constructed according to the Kaplan-Meier method. The effect of different factors on survival was studied using the log-rank test. Two-tailed P values < 0.05 were considered significant.

  Results: Clinical features included abdominal distension (11/15, 73%), abdominal pain (6/15, 40%), ascites (9/15, 60%), abdominal or pelvic masses (14/15, 93%), elevated CA-125 (4/4, 100%), thrombocytosis (4/ 15, 27%), and thrombo-embolic manifestations (3/15, 20%). The response rate to all first-line chemotherapy regimens was 30%. The response rate to paclitaxel/cisplatin was 66.7% and the toxicity was tolerable. The median survival of all patients was 12.5 months. Patients who underwent cytoreductive surgery survived longer than those who underwent biopsy only (median survival 13.5 vs. 6.0 months, P = 0.24). Patients who received chemotherapy survived significantly longer than those who did not receive chemotherapy (29.0 vs. 1.0 months, P = 0.03). Patients who responded to first-line chemotherapy survived significantly longer than those who did not respond (P = 0.04).

  Conclusions: Cytoreductive surgery and chemotherapy, especially with paclitaxel and cisplatin, might be of benefit in women with DMPM.

• Thoracic complications in patients undergoing intraperitoneal heated chemotherapy with mitomycin following cytoreductive surgery. M.Y. Chen, C. Chiles, B.W. Loggie, et al. 1997;66(1):19-23. PubMed · Publisher

  Abstract

  Background: The purpose of this study was to determine the incidence and severity of thoracic reactions in patients undergoing intraperitoneal heated chemotherapy (IPHC).

  Methods: Forty-two patients who had intraperitoneal disseminated malignancies were treated with cytoreductive surgery (CS) and IPHC. The primary malignancies included carcinoma of the colon (n = 17), stomach (n = 6), appendix (n = 6), pseudomyxoma peritonei (n = 3), mesothelium (n = 2), ovaries (n = 2), jejunum (n = 2), gallbladder (n = 1), urachus (n = 1), and peritoneal carcinomatosis (n = 2). After CS, IPHC with mitomycin (MMC) was administered by perfusion at 40.5 degrees C. After IPHC, multiple radiographs of the chest were reviewed in comparison to the control group.

  Results: Thoracic complications occurred in 36 patients (86%), including atelectasis in 32 patients (76%), pleural effusions in 27 (64%), pulmonary edema in 10 (24%), pneumonia in 2 (5%), and pneumothorax in 2 (5%). The incidence of thoracic complications in the IPHC group was significantly higher than that of patients in the control group (P < .05). Correlations between the prevalence of pleural effusion and the dose of MMC, duration of procedure, and presence of thrombocytopenia were not significant (P > .05).

  Conclusions: Bibasilar atelectasis and pleural effusions are common findings after IPHC with MMC, but most of them do not necessarily warrant intervention.

• Intrapleural chemotherapy for patients with incompletely resected malignant mesothelioma: the UCLA experience. J.D. Lee, S. Perez, H.J. Wang, et al. 1995;60(4):262-7. PubMed · Publisher

  Abstract

  From 1986 to 1993, 15 patients with malignant pleural mesothelioma were treated by pleurectomy/decortication and intrapleural cisplatin (100 mg/m2) and cytosine arabinoside (1,200 mg). All patients were without known extrathoracic disease and had a mean age of 63 +/- 7.9 years (range 51-78); 13 were male. Histologic subtype of disease were epithelial (47%), sarcomatoid (27%), and mixed-biphasic (27%). The major morbidity and mortality rates were 13% and 0%, respectively. The mean length of hospital stay was 6.5 +/- 2.1 days. Postoperatively, adjuvant chemotherapy and radiation therapy were given to 46% and 73% of the patients respectively. Median survival from date of treatment was 11.5 months. Those patients with an epithelial histologic subtype experienced significantly improved survival compared to those of sarcomatoid subtype (P = 0.024). Whether adjuvant chemotherapy or radiation therapy were given had no significant effect on survival. These data suggest that although this treatment regimen can be administered with very limited morbidity and no mortality, the role of this approach in the treatment of malignant pleural mesothelioma appears limited and cannot currently be recommended.

• Optimal management of malignant mesothelioma after subtotal pleurectomy: revisiting the role of intrapleural chemotherapy and postoperative radiation. E.R. Sauter, C. Langer, L.R. Coia, et al. 1995;60(2):100-5. PubMed · Publisher

  Abstract

  Malignant pleural mesothelioma (MPM) is a generally fatal disease with no standard treatment. There are encouraging reports using intraperitoneal chemotherapy to treat peritoneal mesotheliomas and intrapleural chemotherapy (IPC) to treat malignant pleural effusions. Our objective was to evaluate the efficacy of IPC after subtotal pleurectomy. Between 1988 and 1992, 20 consecutive patients with diffuse MPM limited to one hemithorax underwent subtotal pleurectomy. Thirteen patients with biopsy-proven MPM known prior to thoracotomy were enrolled in a phase II combined modality protocol consisting of perioperative intrapleural cisplatin (100 mg/m2) and ara-C (1,200 mg) after subtotal pleurectomy, followed by systemic cisplatin (50 mg/m2/week x 8) and mitomycin-C (8 mg/m2, days 1 and 36). Seven patients with MPM could not be enrolled because their diagnosis was made post-thoracotomy. These patients underwent subtotal pleurectomy with (n = 4) or without (n = 3) adjuvant radiation (4,500-5,000 cGy in 3 patients, 2,100 cGy in 1 patient). One of three patients who developed chemotherapy-related nephrotoxicity died, the only treatment-related mortality. All 3 patients requiring postoperative readmission received IPC. Significant morbidity did not occur in patients not receiving chemotherapy. Median survival and time to progression were significantly longer in patients not receiving IPC (21 vs. 9 months, P = 0.04; 12 vs. 6 months, P = 0.01). In conclusion, intrapleural and postoperative systemic chemotherapy resulted in significant toxicity and did not improve survival in our patients who underwent subtotal pleurectomy for MPM.

• Malignant pleural mesothelioma: a clinicopathological study. J.C. Qua, U.N. Rao, H. Takita. 1993;54(1):47-50. PubMed · Publisher

  Abstract

  In this paper the results of a retrospective review of 58 patients with malignant pleural mesothelioma treated at our Institute are reported. There were 50 males and 8 females; the mean age was 56.3 years (range: 13-77). History of asbestos exposure was ascertained in 25 patients (43%). The most common finding in chest X-ray was pleural effusion which was seen in 47/58 patients on presentation. The cytological examination of pleural effusion was most of the time nondiagnostic. Pleural biopsy was needed for the correct diagnosis. Pathologically, 26 patients (44.8%) had epithelial type, 24 patients (41.4%) had mixed type, and 8 patients (13.8%) had fibrous or sarcomatous type of pleural mesothelioma. Most of the patients on presentation had Stage I disease by Butchart's classification. The overall survival time ranged from 1 month to as long as 17 years with a median of 12.5 months. The mean survival of patients who received nonsurgical therapies was 7-13.4 months. Thirteen patients were treated surgically: three patients survived over 5 years, but the median survival was 15 months. Six patients received no treatment, and the median survival was seven months.

• Primary pleural mesotheliomas in south India: a 25-year study. U. Kini, S. Shariff, J.A. Thomas. 1992;49(3):196-201. PubMed · Publisher

  Abstract

  In this report from South India, 15 patients with primary pleural mesothelioma have been diagnosed in the 25-year period 1, April 1966 through 31, March 1991, representing 0.02% of 76,239 biopsies received. The patients were mainly male with a mean age of 46.5 years. All except two had lived in urban Bangalore. None had been exposed to asbestos. The presentation clinically was peculiar, being continuous pricking pain, breathlessness, and cough with sputum. Physical and roentgenogram examination showed massive pleural effusion with irregular pleural thickening. Thoracotomy findings showed a distinct sessile nodularity with many slit-like spaces. Histologically, 14 were epithelial type mesotheliomas and 1 was a sarcomatous type. While the epithelial type neoplasms showed patchy squamoid differentiation, all showed mucin production. The CEA was always observed in areas of moderate differentiation. Spread occurred centrifugally to local structures on the same side as the lesion.

• Metastases to the breast: differential diagnosis from primary breast carcinoma. B. Vergier, M. Trojani, I. de Mascarel, et al. 1991;48(2):112-6. PubMed · Publisher

  Abstract

  Eight patients with breast metastases from primary tumors other than breast carcinoma were studied: 3 malignant melanomas, 2 rhabdomyosarcomas, 1 malignant mesothelioma, 1 appendiceal carcinoid, and 1 epidermoid cervical carcinoma. All had mammographic, histopathologic, and immunohistochemical examinations. The main problem was differential diagnosis from primary breast carcinoma. History of extramammary primary tumor was helpful but breast metastasis was the first clinical feature in 2 cases. Patients had noticed palpable, round, rapid growth masses which were mammographically benign. Pathologic diagnosis was difficult and immunohistochemical studies necessary, whenever the proliferation had histologic features of primary breast carcinoma or when no primary tumor was known. However, some histologic features were of value for diagnosis of metastasis: atypical histologic features for a primary breast carcinoma, a well-circumscribed tumor with multiple satellite foci, the absence of an intraductal component, and the presence of many lymphatic emboli. In adults, the most frequent types of tumors metastasizing in the breast are malignant melanoma and neuroendocrine-like tumors, especially small cell carcinoma and carcinoid. In children, rhabdomyosarcoma is the most common. Accurate diagnosis of breast metastasis is important to avoid unnecessary mastectomy and to implement an appropriate systemic therapy.

• Distinguishing malignant mesothelioma from pulmonary adenocarcinoma: an immuno-histochemical approach using a panel of monoclonal antibodies. S.E. Tuttle, J.G. Lucas, D.M. Bucci, et al. 1990;45(2):72-8. PubMed · Publisher

  Abstract

  A panel of six monoclonal antibodies (MAbs) was employed to evaluate antigen expression in pulmonary adenocarcinomas and mesotheliomas. Monoclonal anti-human milk fat globulin (HMFG-2), anti-carcinoembryonic antigen (NP-2), anti-epithelial membrane antigen (EMA), anti-cytokeratin (PKK-1), anti-tumor-associated antigen 72 (B72.3), and anti-human myelomonocytic antigen (Leu M-1) antibodies were used to localize their respective antigens in formalin-fixed, paraffin-embedded tumors by using the avidin-biotin-complex immunoperoxidase technique. In all, 28 mesotheliomas obtained from Ohio State University Anatomic Pathology files and from a Southwest Oncology Group (SWOG) protocol were compared to 22 pulmonary adenocarcinomas by using this MAb panel. None of the mesotheliomas demonstrated positive staining with MAbs NP-2 (anti-CEA) or Leu M-1. However, 95% (21/22) of adenocarcinomas stained with one of these two antibodies. Although neither of these two MAbs stained all adenocarcinomas, each antibody demonstrated positive immunostaining in more than 90% of the adenocarcinomas studied. Therefore, MABs NP-2 and Leu M-1 are, individually, quite useful for distinguishing mesothelioma from adenocarcinoma. However, in our study, no single MAb could be used to distinguish these two tumor types in every case. MAb B72.3 stained 91% (20/21) adenocarcinomas but also stained 7% (2/28) of mesotheliomas. MAb HMFG-2 reacted positively with 95% of adenocarcinomas, but also stained 39% of the mesotheliomas, usually in a membranous pattern. MAbs EMA and PKK-1 were not found useful in distinguishing mesothelioma from adenocarcinoma. We conclude that MAbs Leu M-1 and NP-2 were both useful in distinguishing mesothelioma from pulmonary adenocarcinoma in that positive staining was demonstrated in adenocarcinomas and not mesotheliomas.

• Malignant pleural mesothelioma: a survival study. J.C. Harvey, E.H. Fleischman, A.R. Kagan, et al. 1990;45(1):40-2. PubMed · Publisher

  Abstract

  Ninety-four patients with malignant pleural mesothelioma were treated at Southern California Permanente Medical Group Facilities between 1965 and 1988. This retrospective analysis of survival in these patients is compared according to surgical and/or supportive management. Group I patients received supportive care only, including pleurodesis as needed. This group included the majority of patients. Group II patients were managed largely with debulking procedures including decortication and pleurectomy. Group III patients received extrapleural pneumonectomy. This group included the two long-term survivors of the entire group. This study of survival points out the need for a cooperative protocol as well as the consistent use of proper modern preoperative staging in an attempt to select patients who benefit from extrapleural pneumonectomy.

1980s

• Adenomatoid tumors in the tunica albuginea of the testis. J.A. Arcadi. 1988;37(1):38-9. Case report PubMed · Publisher

  Abstract

  Adenomatoid tumors of the tunica albuginea of the testis is rarely seen. Only 15 such cases have been described. A patient is presented in whom such a tumor was found and excised through a scrotal incision. He is alive and well 27 years later. The author presents reasons for the type of scrotal exploration done. The pathological histology is discussed. An adenomatoid tumor can easily be confused with a prostatic adenocarcinoma on frozen section.

• Diagnostic histochemical and immunohistochemical studies in malignant mesothelioma. J.G. Lucas, S.E. Tuttle. 1987;35(1):30-4. PubMed · Publisher

  Abstract

  This study was undertaken to evaluate the relative utility of histochemical and immunohistochemical stains in diagnosing malignant mesothelioma of the thorax. We performed a battery of histochemical stains, including periodic acid Schiff (PAS) with and without diastase, mucicarmine, colloidal iron (Coll Fe) with and without hyaluronidase, and immunohistochemical stains for keratin and carcinoembryonic antigen (CEA) on 12 pleural mesothelioma specimens obtained from 11 patients, five primary pulmonary adenocarcinomas, and one metastatic adenocarcinoma each to pleura and pericardium. All diagnoses were established by autopsy or thorough clinical and surgical evaluation. The diagnosis of mesothelioma was established following rigid anatomic criteria. All tissue was formalin fixed and paraffin embedded. Commercially available reagents and antisera were used in all cases. Results showed a high rate of positivity for keratin and hyaluronidase-sensitive Coll Fe in the mesotheliomas while adenocarcinomas were uniformly positive for CEA and keratin and generally positive for PAS-D (diastase) and mucicarmine. Mesotheliomas were negative for CEA, mucin, and PAS-D. Positive keratin staining was also seen in the spindle cell components of mesotheliomas. Immunohistochemical stains often added significantly to our ability to establish the diagnosis of mesothelioma with confidence, since they were more frequently and more clearly positive than histochemical stains.

• Malignant mesothelioma of testicular tunica. I. Vakalikos, E. Destouni, K. Valassis, et al. 1985;29(4):264. Case report PubMed · Publisher

  Abstract

  A case of malignant mesothelioma of testicular tunica in a 26 year old male is presented. Operation was followed by local radiotherapy. The patient remains disease free one year after initial diagnosis.

• Malignant pleural mesothelioma with a 14-year survival: a case report and electronmicroscopic study. M. Klima, H.J. Spjut, M.I. Bossart, et al. 1982;20(4):253-9. Case report PubMed · Publisher

• An unusual presentation of malignant mesothelioma: the incidental finding of tumor in the hernia sac during herniorrhaphy. J. Brenner, P.P. Sordillo, G.B. Magill. 1981;18(2):159-61. Case report PubMed · Publisher

  Abstract

  Two cases of malignant mesothelioma that were found incidently at the time of hernia repair are described. In contrast to the majority of patients with peritoneal mesothelioma, both patients had a relatively prolonged survival after diagnosis, although both eventually died with widespread disease. The possible causes of this unusual presentation are discussed.

  PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

• Radio frequency hyperthermia of advanced human sarcomas. F.K. Storm, R.S. Elliott, W.H. Harrison, et al. 1981;17(2):91-8. Case report PubMed · Publisher

  Abstract

  Hyperthermia greater than or equal to 42 degrees C is tumoricidal in vitro and in many animal models, although such temperatures have only recently been achieved experimentally in some human cancers. A recently developed radio frequency device that provides safe hyperthermia to any depth without surface tissue injury now permits evaluation of the effects of hyperthermia on advanced human sarcomas. Twelve patients with large sarcomas located intraabdominally [7], in the chest wall [2], proximal extremity [2], and the neck [1], were evaluated in this study. Tumor types include liposarcoma [3], rhabdomyosarcoma [2], leiomyosarcoma [2], neurofibrosarcoma [2], and one each malignant mesothelioma, undifferentiated sarcoma, and osteosarcoma. Intratumor temperatures greater than or equal to 42 degrees C were observed in all tumors, with virtually no normal tissue injury. Selective tumor heating greater than or equal to 45 degrees C occurred in 9/12 (75%) and greater than or equal to 50 degrees C in 6/12 (50%). One to five weekly treatments greater than or equal to 50 degrees C and ten daily treatments greater than or equal to 45 degrees C resulted in significant tumor necrosis and pain relief in some patients. Hyperthermia of advanced sarcomas is possible with little host toxicity and may be of potential therapeutic benefit.

• Malignant mesothelioma: a metastasis to the face. L.E. Edstrom, P.J. Dawson, J. Kohler, et al. 1980;14(3):251-4. Case report PubMed · Publisher

  Abstract

  Malignant mesothelioma can be a confusing disease, resembling either carcinoma or sarcoma. Although it usually causes death rapidly by local and regional spread, distant metastases may be seen more frequently as more effective therapy controls local disease and prolongs life. Our patient's local and then regional mesothelioma was controlled by aggressive treatment, which allowed him nearly two years of productive life before a metastasis to the right infraorbital region occurred. He died shortly thereafter with widesspread metastases. This is the first reported case of mesothelioma metastatic to the face. This case also emphasizes the association of malignant mesothelioma with asbestos exposure, and points out advances in pathologic techniques that aid in the diagnosis of the disease.

• Malignant mesotheliomas and chemotherapy. C.P. Karakousis, M. Seddiq, R. Moore. 1980;15(2):181-5. PubMed · Publisher

  Abstract

  Of 77 patients with mesotheliomas, 63.6% had pleural involvement, 31.2% had peritoneal involvement, and 5.2% had involvement at other sites. The presenting symptoms varied with the location of the primary. Surgery and irradiation did not appear to influence the course of the diffuse type. Of 41 patients given systemic chemotherapy, three patients had complete response and four had greater than 50% objective response (median survival 42.5 months); 18 patients had stabilization (median 12.8 months), and 16 showed no response (median 4.5 months). The difference in survival between responders and non-responders was statistically significant (P < 0.001). Of 16 patients who received secondary chemotherapy, four had complete response (median survival 17.5 months), six had stabilization (median 10.5 months), and six had no response (median 2.5 months). Chemotherapy appears moderately effective in the treatment of mesotheliomas.

1970s

• Malignant mesothelioma presenting in the pleura and peritoneum. N.E. Mischler, T. Chuprevich, R.O. Johnson, et al. 1979;11(3):185-91. Case report PubMed · Publisher

  Abstract

  Malignant mesothelioma presenting in the pleura and peritoneum is described in a middle-aged man. The patient lacked significant asbestos exposure which is not unexpected from both the clinical literature and animal inhalation tumor data. Computerized axial tomographic correlation is provided. Partial remission was achieved with the administration of adriamycin and DTIC.

Browse every journal in the library or the library by type of article, or return to medical research.