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    Malignant Mesothelioma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Changes to This Summary (08 / 15 / 2014)

    The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

    General Information About Malignant Mesothelioma Treatment

    Added level of evidence 3iiiA.

    Added Prognostic Scoring Systems as a new subsection.

    Added text to state that multimodality therapy incorporating radical surgery with or without chemotherapy, administered with or without radiation, may be considered for patients with limited disease and has been associated with a relatively long survival in observational series (cited Flores et al. as reference 6 and level of evidence 3iiiA). Also added level of evidence 3iiiD to list of factors associated with improved long-term survival.

    Cellular Classification of Malignant Mesothelioma

    Revised text to state that histologically, these tumors are composed of spindle cells or epithelial elements or both; also added that desmoplastic mesothelioma, consisting of bland tumor cells between dense bands of stroma, is a subtype of sarcomatoid mesothelioma. Added that the epithelioid form is occasionally confused with lung adenocarcinoma or metastatic carcinomas; epithelioid tumors account for approximately 60% of mesothelioma diagnoses (cited Travis et al. as reference 1).

    Revised text to state that examination of the gross tumor at surgery and use of special stains or electron microscopy can often help to determine diagnosis; pancytokeratin stains are positive in nearly all mesotheliomas. Also added that particularly useful immunohistochemical stains for the differential diagnosis of epithelioid mesothelioma include cytokeratin 5 and 6, calretinin, WT-1 and D2-40. Added that calretinin and D2-40 positivity in combination with pancytokeratin positivity is most useful to distinguish sarcomatoid mesothelioma from sarcoma and other histologies (cited Travis et al. as reference 1). Also revised text to state that histologic appearance seems to be of prognostic value, and most clinical studies show that patients with epithelial mesotheliomas have a better prognosis than those with sarcomatoid or biphasic mesotheliomas.

    Stage Information for Malignant Mesothelioma

    Revised text to state that the American Joint Committee on Cancer (AJCC) and International Union Against Cancer (UICC) have designated staging by TNM classification to define malignant mesothelioma.

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