From MD Anderson: Malignant Pleural Mesothelioma: Role of CT, MRI, and PET/CT in Staging Evaluation and Treatment Considerations

http://www.ncbi.nlm.nih.gov/pubmed/24034264

Semin Roentgenol. 2013 Oct;48(4):323-34. doi: 10.1053/j.ro.2013.03.017.

Malignant Pleural Mesothelioma: Role of CT, MRI, and PET/CT in Staging Evaluation and Treatment Considerations.

Truong MT, Viswanathan C, Godoy MB, Carter BW, Marom EM.

Source

Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas, M.D. Anderson Cancer Center, Houston, TX. Electronic address: mtruong@mdanderson.org.

Advances in the treatment of patients with MPM over the past few years include a unified staging system, novel targeted agents, improved radiation therapy techniques for local control, and decreased morbidity and mortality in patients who undergo curative surgical resection.² In addition, the failure of single-modality therapy has led to the increasing use of multimodality regimens combining chemotherapy, radiotherapy, and surgery. In patients with early stage disease, there has been an increasing tendency to perform surgical resection as part of the treatment algorithm. Patients with epithelial histology, a primary tumor that is limited in local extent, and no nodal metastases have the greatest survival benefit following surgical resection.³ Conversely, patients with sarcomatoid histology and nodal metastases have shown poor overall survival after resection and may be treated with palliative chemotherapy. In terms of chemotherapeutic regimens, the use of the antifolate, pemetrexed, in combination with cisplatin has been reported to improve overall survival by 3 months⁴ and is generally accepted as standard therapy for MPM. To optimally evaluate the effectiveness of new treatment options, accurate staging to stratify patients into homogeneous groups for entry into clinical trials is needed. Knowledge of the strengths and limitations of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT is essential in appropriate staging and management of patients with MPM. This review discusses imaging, staging evaluation, and treatment considerations for MPM. Imaging findings with emphasis on the T, N, and M descriptors according to the International Mesothelioma Interest Group staging system is addressed.