Scientific Letter
Malignant Pleural Mesothelioma: The Last 8 Years of Experience in Our Area
Mesotelioma pleural maligno: experiencia de los últimos 8 años en nuestra área
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A Colonizer or a True Pathogen?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "639" "paginaFinal" => "640" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Mycobacterium lentiflavum</span> en pacientes con fibrosis quística: ¿colonizante o patogénico?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 518 "Ancho" => 1300 "Tamanyo" => 62692 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lung CTs of 2 patients with a diagnosis of <span class="elsevierStyleItalic">M. lentiflavum</span> infection. Both patients revealed a clear tree-in-bud image (arrows) with acinar nodules (Δ), mainly in the right upper lobes.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Moreno Ortega, Esther Quintana Gallego, Laura Carrasco Hernández, Esther Pérez Borrego, Isabel Delgado Pecellín" "autores" => array:5 [ 0 => array:2 [ "nombre" => "María" "apellidos" => "Moreno Ortega" ] 1 => array:2 [ "nombre" => "Esther" "apellidos" => "Quintana Gallego" ] 2 => array:2 [ "nombre" => "Laura" "apellidos" => "Carrasco Hernández" ] 3 => array:2 [ "nombre" => "Esther" "apellidos" => "Pérez Borrego" ] 4 => array:2 [ "nombre" => "Isabel" "apellidos" => "Delgado Pecellín" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289618301637" "doi" => "10.1016/j.arbres.2018.02.025" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289618301637?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918303318?idApp=UINPBA00003Z" "url" => "/15792129/0000005400000012/v1_201812020625/S1579212918303318/v1_201812020625/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S157921291830329X" "issn" => "15792129" "doi" => "10.1016/j.arbr.2018.10.001" "estado" => "S300" "fechaPublicacion" => "2018-12-01" "aid" => "1881" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2018;54:635-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 442 "formatos" => array:3 [ "EPUB" => 71 "HTML" => 226 "PDF" => 145 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Tuberculosis and Microscopic Polyangiitis. A Rare Combination" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "635" "paginaFinal" => "637" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tuberculosis y poliangitis microscópica. Una asociación muy poco frecuente" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3684 "Ancho" => 3000 "Tamanyo" => 1894464 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest high-resolution computed tomography (HRCT). No evidence of disease or pleural effusion observed in middle and lower fields. (B) Lung biopsy. Granulomatous inflammation with extensive areas of necrosis and multinucleated Langhans giant cells. (C) Chest HRCT. Diffuse increase of pulmonary radiodensity, mainly ground glass opacities with moderate left loculated pleural effusion, and a fissural component, interpreted as diffuse alveolar hemorrhage. (D) Renal biopsy. Renal glomerulus with area of focal necrosis and karyorrhexis. (E) Renal biopsy with fibrinoid necrosis of the small arteries affecting more than 50% of the circumference, associated with transmural inflammation. (F) Chest HRCT. Reduction of pleural effusion and slight improvement of the ground glass opacities.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vanessa Riveiro, Jorge Ricoy, María E. Toubes, Luis Valdés" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Vanessa" "apellidos" => "Riveiro" ] 1 => array:2 [ "nombre" => "Jorge" "apellidos" => "Ricoy" ] 2 => array:2 [ "nombre" => "María E." 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Treatment may include surgical resection, chemotherapy (CT), radiation therapy, or a combination of all 3. We report a descriptive retrospective study that evaluates clinical and pathological features, type of treatment, and survival in patients diagnosed with this disease in our region (Vallés Occidental, Barcelona) between 2008 and 2016.</p><p id="par0010" class="elsevierStylePara elsevierViewall">There were 44 cases of MPM in total. Most patients were men (84%), and 56.8% were 70 years of age or older. Twenty-five patients had epithelioid type disease, 1 biphasic, 2 sarcomatoid, and 16 with no specific histology. Twenty-four (54.6%) were smokers. Nine (20.5%) had a history of asbestos exposure.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Most were in advanced stages at diagnosis, 35 (79.5%) in stages III and IV, and 9 (20.5%) in stages I and II. Twenty-three (52.3%) had performance status (PS) 0–1, and 21 (47.7%) had PS 2–3.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Surgery was indicated in 2 patients (4.5%); in 1 to limit symptoms and for disease diagnosis, and in the other due to very good response to systemic therapy and good PS in a young patient. The remaining patients were treated with talc pleurodesis. Twenty-one patients (47.7%) received first-line CT with cisplatin-pemetrexed, and 4 (9%) showed partial response or stable disease. Ten patients (47.6%) received a second line of treatment after progression, 5 (50%) with vinorelbine and 5 (50%) with gemcitabine.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Mean overall survival (OS), analyzed by the Kaplan–Meier method, was 14 months (95% CI: 11.6–16.4), with no differences between men and women (14 vs 16 months) (<span class="elsevierStyleItalic">P</span>=0.91). There were no significant differences in OS between patients with epithelioid tumors (15 months) and those with other histologies (14 months) (<span class="elsevierStyleItalic">P</span>>0.6). OS in terms of stages I/II/III/IV was 11, 15, 14 and 11 months, respectively (<span class="elsevierStyleItalic">P</span>>0.5). In patients treated with CT, OS was 15 months compared to 11 months in untreated patients (<span class="elsevierStyleItalic">P</span>>0.3).</p><p id="par0030" class="elsevierStylePara elsevierViewall">MPM is a rare tumor that is difficult to diagnose and therapeutic options are limited. In up to 80% of cases, it is associated with occupational exposure to asbestos.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> Symptoms include the development of pleural effusion, dyspnea or pain.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Computed tomography (CT) is the radiological diagnostic procedure of choice; it reveals diffuse pleural thickening and nodular lesions, although it lacks sensitivity in the assessment of mediastinal or contralateral involvement. The extension study can be completed with PET or a PET-CT.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> Cytological analysis of pleural fluid helps differentiate the diagnosis from metastatic tumors.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> Thoracoscopy is the technique of choice for obtaining guided biopsy samples. Better staging can be achieved with video-assisted thoracoscopy, and pleurectomy or decortication can be performed in selected cases.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> In our series, diagnosis was made using CT; the study can be completed with a PET in certain patients in whom surgery is proposed by the multi-disciplinary committee. The pathology analysis is performed on biopsies obtained by thoracoscopy or fine-needle aspiration and biopsy.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Histological types vary between epithelioid, sarcomatoid, and biphasic; other rare subtypes are desmoplastic, small cell, and lymphohistiocytoid.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">OS is estimated to be around 1 year<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a>; in our series, it was 14 months. The benefit of surgery is controversial, as it seems to have little effect on survival in most studies, whereas associated morbidity and mortality are high.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> In 2011, Treasure et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a> conducted a randomized study in the United Kingdom that had a high impact on clinical practice. They found no significant differences in survival, which was lower in operated patients, while interventions were associated with high morbidity and mortality. Given these results and those of other non-randomized trials, controversy regarding the role of radical surgery is rife. Ongoing studies, such as MARS2, are analyzing the role of decortication compared to radical surgery.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a> The current evidence has prompted clinicians to reserve surgery for the local control of symptoms, pain, or pleural effusion.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> Surgery was indicated for the control of incapacitating pleuritic pain in 1 of the patients from our series; the other operated patient, who was young with a good PS, underwent surgery after good response to CT. Surgery was performed in these 2 highly selected patients only, taking into consideration the risk and the limited potential benefit of the intervention.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Prompt initiation of treatment improves prognosis.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a> Radiation therapy can play an important role in the control of pain. OS is greater with combined cisplatin and pemetrexed<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> than with single-agent cisplatin (12 vs 8–9 months).<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">9,10</span></a> CT confers a limited increase in OS (15 months in our series), with improved control of symptoms. In case of progression, the second line of treatment can include pemetrexed as a single agent (if it was not used in first line), gemcitabine or vinorelbine.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In addition to CT, studies with other agents have shown an improved prognosis in MPM patients. The combination of nintedanib (an anti-angiogenic tyrosine kinase inhibitor) and CT in a phase II study has shown an increase in progression-free survival, and a trend toward a longer OS compared to CT alone.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> Finally, other options currently under development for second and third-line treatment are based on anti-PD-1 agents, such as pembrolizumab<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a> or nivolumab, and its combination with ipilimumab, under study in a phase II trial in comparison with monotherapy.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Despite its retrospective nature, our series provides experience in the surgical and systemic management and prognosis of a group of patients with this rare tumor. The best treatment for MPM is still to be determined. Surgery is associated with significant perioperative morbidity, and is performed only in highly selected cases in whom the risk of the procedure is understood. CT achieves a limited increase in survival, but it is associated with better control of symptoms. New systemic therapies could provide better outcomes in the prognosis of this disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Benítez JC, Campayo M, Call S, Bastús R. Mesotelioma pleural maligno: experiencia de los últimos 8 años en nuestra área. Arch Bronconeumol. 2018;54:637–638.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnóstico y tratamiento del mesotelioma pleural maligno" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 1 | 6 |
| 2024 October | 33 | 26 | 59 |
| 2024 September | 35 | 13 | 48 |
| 2024 August | 52 | 45 | 97 |
| 2024 July | 36 | 19 | 55 |
| 2024 June | 58 | 29 | 87 |
| 2024 May | 72 | 27 | 99 |
| 2024 April | 31 | 33 | 64 |
| 2024 March | 31 | 19 | 50 |
| 2024 February | 32 | 21 | 53 |
| 2023 March | 3 | 2 | 5 |
| 2023 February | 25 | 22 | 47 |
| 2023 January | 24 | 30 | 54 |
| 2022 December | 35 | 39 | 74 |
| 2022 November | 39 | 25 | 64 |
| 2022 October | 49 | 31 | 80 |
| 2022 September | 23 | 27 | 50 |
| 2022 August | 33 | 46 | 79 |
| 2022 July | 25 | 36 | 61 |
| 2022 June | 19 | 24 | 43 |
| 2022 May | 26 | 38 | 64 |
| 2022 April | 27 | 27 | 54 |
| 2022 March | 29 | 43 | 72 |
| 2022 February | 34 | 39 | 73 |
| 2022 January | 23 | 29 | 52 |
| 2021 December | 22 | 40 | 62 |
| 2021 November | 27 | 38 | 65 |
| 2021 October | 25 | 41 | 66 |
| 2021 September | 25 | 43 | 68 |
| 2021 August | 18 | 38 | 56 |
| 2021 July | 16 | 21 | 37 |
| 2021 June | 23 | 26 | 49 |
| 2021 May | 27 | 43 | 70 |
| 2021 April | 83 | 56 | 139 |
| 2021 March | 43 | 22 | 65 |
| 2021 February | 22 | 23 | 45 |
| 2021 January | 18 | 7 | 25 |
| 2020 December | 21 | 22 | 43 |
| 2020 March | 12 | 4 | 16 |
| 2020 February | 11 | 13 | 24 |
| 2020 January | 40 | 9 | 49 |
| 2019 December | 39 | 6 | 45 |
| 2019 November | 25 | 14 | 39 |
| 2019 October | 23 | 16 | 39 |
| 2019 September | 20 | 7 | 27 |
| 2019 August | 21 | 20 | 41 |
| 2019 July | 21 | 20 | 41 |
| 2019 June | 21 | 5 | 26 |
| 2018 December | 1 | 0 | 1 |
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