Assessment of tumor response in malignant pleural mesothelioma.
Most patients with malignant pleural mesothelioma (MPM) are candidates for chemotherapy during the course of their disease. Assessment of the response with conventional criteria based on computed tomography (CT) measurements is challenging, due to the circumferential and axial pattern of growth of MPM. Such difficulties hinder an accurate evaluation of clinical study results and make the clinical management of patients critical. Several radiological response systems have been proposed, but neither WHO criteria nor the more recent RECIST unidimensional criteria nor hybrid uni- and bidimensional criteria seem to apply to tumor measurement in this disease. Recently, modified RECIST criteria for MPM have been published. Although they are already being used in current clinical trials, they have been criticized based on the high grade of inter-observer variability and on theoretical studies of mesothelioma growth according to non-spherical models. Computer-assisted techniques for CT measurement are being developed. The use of FDG-PET for prediction of response and, more importantly, of survival outcomes of MPM patients is promising and warrants validation in large prospective series. New serum markers such as osteopontin and mesothelin-related proteins are under evaluation and in the future might play a role in assessing the response of MPM to treatment.
Ceresoli
Giovanni L
GL
Department of Medical Oncology and Hematology, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy. giovanni_luca.ceresoli@humanitas.it
Chiti
Arturo
A
Zucali
Paolo A
PA
Cappuzzo
Federico
F
De Vincenzo
Fabio
F
Cavina
Raffaele
R
Rodari
Marcello
M
Poretti
Dario
D
Lutman
Fabio Romano
FR
Santoro
Armando
A
D000970:Antineoplastic Agents / Q000627:therapeutic use; D018450:Disease Progression; D006801:Humans; D008654:Mesothelioma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
D000970:Antineoplastic Agents