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• W1979133732 abstract "Le mésothéliome pleural malin (MPM) reste une tumeur rare de l’adulte consécutive à l’exposition professionnelle aux fibres d’amiante. Son incidence augmentera jusqu’en 2020-2030. Elle est de 100 cas/million/an dans la population exposée à l’amiante contre moins de 1 cas/million d’habitants et par an dans la population générale non exposée, soit 800 à 1 000 cas/an en France. La carcinogenèse moléculaire, imparfaitement comprise, fait intervenir des altérations des gènes NF2, c-met, WT1 RASSF1 et p16, impliqués dans l’invasion et la motilité cellulaire, le contrôle de la division cellulaire et l’apoptose. Le diagnostic histologique est difficile, et repose sur une analyse immunohistochimique codifiée par le groupe Mésopath. La thoracoscopie est l’examen de base, avec des biopsies profondes. Le rôle de la TEP-FDG émerge dans le bilan d’extension. La prise en charge thérapeutique repose sur l’irradiation précoce des trajets de ponction et biopsies, et parfois, chez des patients sélectionnés, sur la pleuropneumonectomie extrapleurale élargie. La chimiothérapie à base de doublets d’antifolate (pemetrexed) et sel de platine, a démontré, en phase III, un allongement de la survie et une amélioration de la qualité de vie. L’apport d’agents anti-angiogéniques (bevacizumab) pourrait s’avérer intéressant, mais reste à évaluer, un essai de phase III (Mesothelioma Avastin Pemetrexed Study : MAPS) étant actuellement coordonné par l’Intergroupe Francophone de Cancérologie Thoracique (IFCT). Malignant pleural mesothelioma (MPM) is a rare tumour due to occupational asbestos exposure. The incidence of MPM will continue to increase until 2020-2030. The incidence reaches 100 cases/million/year in occupationally exposed populations as opposed to 1 case/million/year in the general population, leading to 800 to 1,000 cases per year in France. The molecular carcinogenesis of MPM is incompletely understood but alterations to genes NF2, c-met, WT1 RASSF and p16 have been described. These genes are involved in cell invasion and motility, cell division and apoptosis control. Histological diagnosis remains difficult and depends on immunohistochemical analysis as described by the French Mesopath group. Clinical diagnosis relies on thoracoscopy and large pleural biopsies, with increasing use of CT-PET for the evaluation of disease extent. Therapeutic strategy includes prophylactic irradiation following drainage or thoracoscopy to prevent tumour nodule development along drainage channels and puncture sites. In selected patients, extensive extra-pleural pneumonectomy can be performed with curative intent. First line chemotherapy is based on a combination of pemetrexed and cisplatin that has demonstrated an improvement in overall survival and quality of life in phase 3 trials. Antiangiogenic agents such as bevacizumab (Avastatin) may be of interest but need to be tested in phase 3 trials. The Mesothelioma Avastatin Pemetrexed Study (MAPS) is ongoing, coordinated by the French Thoracic Cancer Intergroup (IFCT)." @default.
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• W1979133732 date "2007-10-01" @default.
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• W1979133732 title "Prise en charge dignostique et thérapeutique du mésothéliome pleural malin en 2007" @default.
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