Mesothelioma Flashcards
Other less common locations for mesothelioma
- peritoneal mesothelioma
- pericardial
- tunica vaginalis testis
Other RF’s for mesothelioma
prior thoracic XRT (hodgkins treatment)
*Smoking is not
Genetic syndrome associated with mesothelioma + what it stands for
BAP1 (BRCA1 associated protein)
preferred upfront systemic therapy for sarcomatoid
ipi-nivo
preferred upfront systemic therapy for biphasic (mixed histology)
ipi-nivo
preferred upfront systemic therapy for epithelioid
- platinum pemetrexed +/- bev
- nivo-ipi
*cis or carbo/pemetrexed + pembrolizumab for 6 cycles, w/ pembro maintenance for up to 2 years (NOT approved or on NCCN yet)
Management of resectable epithelioid
Upfront platinum/pemetrexed rather than decortication surgery (MARS2)
Screening for mesothelioma in patients with asbestos exposure
- not recommended (trials didn’t show survival benefit)
Pleural mesothelioma subtypes
- biphasic
- sarcomatoid
- Epithelioid
Stage II mesothelioma
N1 disease
Resectable mesothelioma stages
Stage I-IIIA
What precludes surgery in mesothelioma
IIIB
1) N2 (contralateral lymphadenopathy)
2) T4 -
T4 in mesothelioma
1) Diffuse extension or multifocal masses of tumor in the chest wall, with or without associated rib destruction
2) Direct transdiaphragmatic extension of tumor to the peritoneum
3) Direct extension of tumor to the contralateral pleura
4) Direct extension of tumor to mediastinal organs
5) Direct extension of tumor into the spine
6) Tumor extending through to the internal surface of the pericardium with or without a pericardial effusion, or tumor involving the myocardium
Management of stage I-IIIA
Induction chemotherapy then surgery (confirm still SOC after MARS data)
1) Surgical options for mesothelioma 2) which type requires adjuvant XRT
1) PD (pleurectomy decortication) (removes tumor + visceral pleura)
2) EPP (extrapleural pneumonectomy) (en bloc removal of affected lung parietal pleura, diaphragm and mediastinal lymph nodes)
*EPP requires adjuvant radiation
