For patients with pleural mesothelioma, removal of their tumors can make a significant difference in survival time, but not everybody is a surgical candidate. Some malignant masses are inoperable (or unresectable), but that’s often not known without taking the patient to surgery and seeing what’s hidden in the pleural cavity. This is a significant challenge, but a recent study conducted by researchers from Memorial Sloan Kettering Cancer Center has identified key clinical and radiological features that could significantly improve preoperative decision-making.
Study Looks for Predictive Characteristics in Mesothelioma
The retrospective study published in the journal European Radiology reviewed the medical records for mesothelioma patients who had undergone comprehensive imaging analysis before surgery. Researchers identified 133 patients whose tumors had been presumed to be operable. They examined 22 different radiological characteristics using CT and PET/CT scans, paying particular attention to pleural thickness at multiple thoracic levels. They then compared the clinical differences between the patients who turned out to be eligible for tumor removal and those whose surgery revealed inoperable tumors.
The researchers found a strong correlation between mesothelioma that was operable and several specific clinical and imaging features. Among the 133 patient records studied, they found that 52% had successfully removable tumors while 48% turned out to be inoperable. The predictive factors that correlated with operability or inoperability included the patients’ asbestos exposure history, whether they’d undergone previous treatments, their clinical tumor stage, the thickness of their pleura, lung invasion patterns, and chest wall involvement. The most significant factors were changes to the extrapleural space, whether the tumor had extended into the subphrenic area, and whether the mediastinum was involved. Each of these indicated a more advanced disease.
Study Yields Advanced Mesothelioma Prediction Models
As a result of this research, surgeons were able to develop two highly accurate predictive models for planning mesothelioma surgery. Both demonstrated excellent diagnostic performance, with the first model using upper-level pleural thickness measurements, extrapleural space changes, and mediastinal involvement, and the second using clinical variables with radiological findings through comprehensive tumor staging. Both provided clinicians with robust tools for treatment planning.
Roughly half of pleural mesothelioma patients are incorrectly staged before surgery. This often leads to unnecessary procedures and appropriate treatment being delayed. As a result of this study and the models that were developed from its findings, physicians will have better information for treatment decisions, allowing them to significantly improve their preoperative assessment and avoid moving forward with unnecessary surgeries. It will also let them move on to alternative therapies like chemotherapy or radiation more quickly.
Every day, scientists are learning more about how best to treat mesothelioma. If you’ve been diagnosed with this rare and challenging disease and need more information, contact the Patient Advocates at Mesothelioma.net today at 1-800-692-8608.
