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J Thorac Cardiovasc Surg 2003;126:15-16
© 2003 The American Association for Thoracic Surgery

General thoracic surgery

Discussion

Dr David J. Sugarbaker (Boston, Mass). I very much appreciated the opportunity to read the article by Dr Flores and his group at Memorial regarding this interesting study of PET and mesothelioma. I think it is important to look for different modalities to understand preoperatively the extent of disease in mesothelioma, and I suggest that the findings in this particular study are not unexpected. The difficulty of defining the preoperative stage in mesothelioma is derived from the fact that the geographical distribution of the tumor, unlike other malignancies, is very diffuse, and all of the modalities, including MRI and CT scan (which preceded PET), have had difficulty in defining preoperatively the appropriate stage. Nevertheless, this study suggests that there are some limited useful applications of PET in mesothelioma, particularly in those malignancies that have a high metabolic rate taking up a lot of the markers; thus, there is the implication of a very high mitotic index and therefore a higher propensity to spread to the lymph nodes. Unfortunately, there is a very small group of patients who will demonstrate distant metastatic disease at the time of presentation. Nevertheless, in this small group of patients, it seems that PET has some usefulness.

I have 3 questions for Dr Flores and his group at Memorial, who obviously have extensive experience with mesothelioma. First, I believe 21 patients in your series were "open and close," unresectable. Given the limited cohort you had, this seems to be a relatively high unresectability rate. Would you address that and tell us if there was anything in the MRI, CT, or other aspects of the preoperative workup that may have indicated that these patients were indeed unresectable before their exploration? As a sideline to that question, was there a propensity for these patients to be mixed or . . . [Full Text of this Article]

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Positron emission tomography defines metastatic disease but not locoregional disease in patients with malignant pleural mesothelioma

Raja M. Flores, Timothy Akhurst, Mithat Gonen, Steven M. Larson, and Valerie W. Rusch
J. Thorac. Cardiovasc. Surg. 2003 126: 11-15. [Abstract] [Full Text] [PDF]