MesotheMesotheFlying uFlying u

Rad

Dr.George KC lt t ThConsultant,Th

Tata Memo

elioma -elioma nder thender the dar

Karimundackalh i S ihoracic Servicesorial Hospital

BackgBackg

• M li t l• Malignant neoplaspleural or peritonepleural or peritone

• 75-80% arise in th75-80% arise in th

• Peritoneum pericaPeritoneum, perica

groundground

i i f thsm arising from the al surfaceal surface

e pleurae pleura

ardiumardium

•• Strong co-relationasbestosasbestos

• First established i• First established i

• Most common in I• Most common in I

• Fi t d l ti• First degree relati

•• Rare without asbe

n with exposure to

in 1960(South Africa)in 1960(South Africa)

Industrial workersIndustrial workers

l ff t dves also affected

estos exposure

IncidIncid

US figures

enceence

UK figures

The TMThe TM

•• 127 cases (1985 -

• 116 pleural mesoth

• 11 peritoneal meso

• Male : Female - 91

• 50% in the age ran

H StoryH Story

2008)

helioma

othelioma

1: 36

nge 40 - 60

The lyears(200years(200

• 36 cases

• Male : Female - 2

• Median Age - 46

ast 5 03-2008)03 2008)

4 : 12

TreTre

Lung Cancer

ndsnds

Mesothelioma

Lung Cancer Mesothelioma

Statedi t ibdistrib

• Maharashtra - 14

• Madhyapradesh -y p

• Rajasthan - 3Rajasthan 3

• Bihar - 2Bihar 2

• Gujarat - 2Gujarat - 2

• Orissa 3• Orissa - 3

wise b tibution

4

ExpoExpo

•Only 3 / 36 patientsOnly 3 / 36 patients of exposure.p

•May be a reflectionMay be a reflection capture mechanism

osureosure

had definite historyhad definite history

of the poor dataof the poor data m

ManagManag

• N id• No consensus guid

• Surgery - integral ptreatmenttreatment

• Broadly based on• Broadly based on Cardiopulmonary rCardiopulmonary rPerformance statu

gementgement

d lidelines

part of curative

StageStage, reserve and reserve and

us.

StagStaggingging

TreatmentTreatment • Early Stage y g• Surgery followed bg y

chemotherapy and• Neoadjuvant chem

surgery and radiatisurgery and radiati• Advanced DiseaseAdvanced Disease• Palliative chemoth• Palliative chemoth

ModalitiesModalities

by adjuvant y jd radiationmotherapy followed by ionioneeerapyerapy

SurgicalSurgical

• Extrapleural pneum

• Decortication

OptionsOptions

monectomy

In TIn T

• 4 / 36 patients und

• 3 - Extrapleural pn

• 1- Decortication

• Remaining - palliachemotherapy/bes

TMHTMH

derwent surgery

neumonectomy

ative st supportive care

CasCas• 55 year old maley

• Factory workerFactory worker

• BilaspurBilaspur

• h/o recent onset dyh/o recent onset dyeffusion aspirated p

• Pleural fluid cytoloy

• TMH review Epith

se 1se 1

yspnoea and pleuralyspnoea and pleural multiple timesp

ogy - adenocagy

heloid mesothelioma

Localized disease

Underwent left t l lextrapleural

pneumonectomy

Adjuvant chemotherapy and radiation

Cas

1 year old male

Office worker

hane

Sarcomatoid th limesothelioma

NACT - Pemetrexed

se 2

CasCas51 year old male51 year old male

T d iTreated as metastatic adenoca with palliative chemotherapy.

TMH review - mesothelioma

Contralateral metastases at time of re evaluationtime of re evaluation

2 d li h2nd line chemo -pemetrexed

se 3se 3

CommonCommon misstepsmissteps• Pleural effusion

• Intercostal drainag

• No CECT

• Difficulty in achievDifficulty in achievdiagnosis

• Palliative h thchemotherapy

The ShorThe Shor

• No Mesothelioma

• Hospital based regfl t th t l fireflect the actual fi

•• Delayed diagnosis

• Lack of multidiscip

rtcomingsrtcomings

Registry

gistries may not gures

s/Misdiagnosis

plinary teams

SoluSolu

• Implement a ban o• Implement a ban o

• Mesothelioma Reg• Mesothelioma Reg

• Hi h i d f• High index of suspoccupationally expoccupationally exp

• Dedicated MultidisDedicated Multidismanagementg

utionution

on Asbestoson Asbestos

gistrgistry

i i f thpicion for those posedposed

sciplinary team forsciplinary team for

ThankThankk youk you