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Chemotherapie is momenteel de behandeling die het meest wordt toegepast bij niet-operabele mesothelioompatienten. Het gebruik van antifolaten in combinatie met platinum geeft daarbij de grootste kans op langere overleving. Bij patienten die wel geopereerd kunnen worden biedt een combinatie van opereren, bestralen en chemo (trimodale of multimodale behandeling) de beste overlevingskansen. Er is geen standaardtherapie voor de tweedelijnsbehandeling. Bron: Fennell, D., et al. (2008). Advances in the systemic therapy of malignant pleural mesothelioma. Nature Clinical Practice, 5, 3, p. 136-147. Kaufman, A.J. &amp. Pass, H.I. (2008). Current concepts in malignant pleural mesothelioma. Expert Rev. Anticancer Ther. 8(2), 293-303.

Kaufman, A.J. &amp. Pass, H.I. (2008). Current concepts in malignant pleural mesothelioma. Expert Rev. Anticancer Ther. 8(2), 293-303.
Abstract
Malignant pleural mesothelioma (MPM) is a rare but lethal cancer associated with asbestos exposure. Worldwide, the incidence of MPM is expected to increase over the next 20 years. The molecular and genetic profiling of MPM tumors and patients, and improved understanding of the pathogenesis of MPM may lead to novel diagnostic, preventative and therapeutic strategies. Treatment options for MPM remain limited and no consensus exists at this time. Multimodality therapy that combines surgery, chemotherapy and radiation offers the best chance for long-term survival in select patients.

Fennell, D., et al. (2008). Advances in the systemic therapy of malignant pleural mesothelioma. Nature Clinical Practice, 5, 3, p. 136-147.
Abstract
Malignant pleural mesothelioma is an aggressive thoracic malignancy associated with exposure to asbestos, and its incidence is anticipated to increase during the first half of this century. Chemotherapy is the mainstay of treatment, yet sufficiently robust evidence to substantiate the current standard of care has emerged only in the past 5 years. This Review summarizes the evidence supporting the clinical activity of chemotherapy, discusses the use of end points for its assessment and examines the influence of clinical and biochemical prognostic factors on the natural history of malignant pleural mesothelioma. Early-phase clinical trials of second-line and novel agents are emerging from an increased understanding of mesothelioma cell biology. Coupled with high-quality translational research, such developments have real potential to improve the outlook of patients at a time of increasing incidence.

Een 77-jarige man die met asbest heeft gewerkt, 45 jaar heeft gerookt, en bij wie longkanker in de familie op jonge leeftijd voorkomt, heeft bijna 10 x zoveel kans om binnen vijf jaar longkanker te krijgen als iemand met dezelfde kenmerken die nooit gerookt heeft. Cassidy et al. ontwikkelden een model waarmee geschat kan worden hoeveel kans iemand heeft binnen 5 jaar longkanker te krijgen. Meer onderzoek is nodig. Bron: Cassidy, A. et al., (2008). The LLP risk model: an individual risk prediction model for lung cancer. British Journal of Cancer, 98, 270-276.

Cassidy, A. et al., (2008). The LLP risk model: an individual risk prediction model for lung cancer. British Journal of Cancer, 98, 270-276.
Abstract
Using a model-based approach, we estimated the probability that an individual, with a specified combination of risk factors, would develop lung cancer within a 5-year period. Data from 579 lung cancer cases and 1157 age- and sex-matched population-based controls were available for this analysis. Significant risk factors were fitted into multivariate conditional logistic regression models. The final multivariate model was combined with age standardised lung cancer incidence data to calculate absolute risk estimates. Combinations of lifestyle risk factors were modelled to create risk profiles. For example, a 77-year-old male non-smoker, with a family history of lung cancer (early onset) and occupational exposure to asbestos has an absolute risk of 3.17% (95% CI, 1.67&ndash.5.95). Choosing a 2.5% cutoff to trigger increased surveillance, gave a sensitivity of 0.62 and specificity of 0.70, while a 6.0% cutoff gave a sensitivity of 0.34 and specificity of 0.90. A 10-fold cross validation produced an AUC statistic of 0.70, indicating good discrimination. If independent validation studies confirm these results, the LLP risk models&rsquo. application as the first stage in an early detection strategy is a logical evolution in patient care.

Bij veel mensen die vóór 1980 in een vermiculietfabriek in Libby, Montana hebben gewerkt zijn afwijkingen aan de longen te zien, zoals pleurale verdikking. Ook lage blootstellingsniveaus kunnen longafwijkingen veroorzaken. Oorzaak zijn de amfibool asbestvezels die in de vermiculietmijn voorkwamen.Bron: Rohs, A.M. e..a. (2008).

Lockey, J.E., (2008). Low-level fiber-induced radiographic changes caused by Libby vermiculite: a 25-year follow-up study. American Journal of Respiratory and Critical Care Medicine, Mar 15.177(6):630-7.

ABSTRACT
RATIONALE: From 1921 to 1990, vermiculite ore from Libby, Montana, was shipped worldwide for commercial and residential use. A 1980 study of a manufacturing facility using Libby vermiculite was the first to demonstrate a small but significant prevalence of pleural chest radiographic changes associated with amphibole fibers contained in the ore. OBJECTIVES: This follow-up study of the original cohort evaluated the extent of radiographic changes and cumulative fiber exposure (CFE) 25 years after cessation of exposure. METHODS: From the original cohort of 513 workers, 431 (84%) were living and available for participation and exposure reconstruction. Of these, 280 (65%) completed both chest radiographs and interviews. Primary outcomes were pleural and/or interstitial changes. MEASUREMENTS AND MAIN RESULTS: Pleural and interstitial changes were demonstrated in 80 (28.7%) and 8 (2.9%) participants, respectively. Of those participants with low lifetime CFE of less than 2.21 fiber/cc-years, 42 (20%) had pleural changes. A significant (P &lt. 0.001) exposure-response relationship of pleural changes with CFE was demonstrated, ranging from 7.1 to 54.3% from the lowest to highest exposure quartile. Removal of individuals with commercial asbestos exposure did not alter this trend. CONCLUSIONS: This study indicates that exposure within an industrial process to Libby vermiculite ore is associated with pleural thickening at low lifetime CFE levels. The propensity of the Libby amphibole fibers to dramatically increase the prevalence of pleural changes 25 years after cessation of exposure at low CFE levels is a concern in view of the wide national distribution of this ore for commercial and residential use.

Sinds mei is in de VS de eerste elektronische databank voor mesothelioom online toegankelijk voor onderzoekers. De “National Mesothelioma Virtual Bank” bevat kenmerken van 900 monsters van mesothelioomweefsel van 600 patiënten. De databank is ondergebracht bij de Mesothelioma Applied Research Foundation (MARF), een non-profit stichting waarin nabestaanden, artsen, juristen en onderzoekers samenwerken in de strijd tegen mesothelioom. Bron: MARF, 13 mei 2008. Meer http://www.mesotissue.org/

Mesothelioompatiënten die een operatie ondergaan waarbij de zieke long, het aangetaste vlies, hartzakje en middenrif worden verwijderd hebben meer complicaties dan andere patënten maar leven gemiddeld vijf maanden langer. Bron: Schipper, P.H. et al., (2008). Surgery for malignant pleural mesothelioma. Ann. Thorac. Surg.. 85:257-64.

Schipper, P.H. et al., (2008). Surgery for malignant pleural mesothelioma. Ann. Thorac. Surg.. 85:257-64.
Abstract
Background. Malignant pleural mesothelioma is a rare, aggressive, and deadly malignancy. Despite increasing incidence, no treatment modality is accepted standard of care. This report analyzes our experience with surgical management of mesothelioma.
Methods. All patients with surgery for mesothelioma from January 1985 through December 2003 were retrospectively reviewed.
Results. There were 285 patients with a median age of 66 years (range, 26 to 91 years). One hundred forty-six patients (51%) had biopsy only, 73 (26%) had extrapleural pneumonectomy, 34 (12%) had subtotal parietal pleurectomy, 22 (8%) underwent exploration without resection, and 10 (3%) had total pleurectomy. Histopathology was epithelial, nonepithelial, and unclassified in 134, 108, and 43 patients, respectively. Twenty patients were stage IA, 82 patients were stage IB, 24 patients were stage II, 75 patients were stage III, 60 patients were stage IV, and 24 patients were of unknown stage. Fifty-three patients (19%) had chemotherapy alone, 16 (5.6%) had radiation alone, and 42 (14.7%) had both. Thirty-day operative mortality was 6.3% and was not significantly associated with the operative procedure (p 0.79). Fifty-one percent of extrapleural pneumonectomy patients had major complications, significantly greater than patients having any other procedure (p &lt. 0.001). Median follow-up was 11 months (range, 0 to 7 years). Overall median survival was 10.7 months. however, for patients having extrapleural pneumonectomy, median survival was 16 months. One-, 2-, and 3-year survival after extrapleural pneumonectomy was 61%, 25%, and 14%, respectively.
Conclusions. Extrapleural pneumonectomy can be performed
with similar 30-day mortality as other procedures for malignant pleural mesothelioma with a median survival better than subtotal pleurectomy, exploration without resection, and biopsy alone. However, extrapleural pneumonectomy has significant morbidity and a 3-year survival of only 14%.

Amosiet asbest veroorzaakt zowel niet-kwaadaardige als kwaadaardige asbestziekten. Het is echter minder schadelijk dan het blauwe crocidoliet asbest. In Zuid Afrika zijn de meeste mijnwerkers zowel aan amosiet- als aan crocidoliet-asbest blootgesteld. Bron: Murray, J. &amp. Nelson, G., (2007). Health effects of amosite mining and milling in South Africa. Regul. Toxicol. Pharmacol. (2007), doi:10.1016/j.yrtph.2007.09.011.

Murray, J. &amp. Nelson, G., (2007). Health effects of amosite mining and milling in South Africa. Regul. Toxicol. Pharmacol. (2007), doi:10.1016/j.yrtph.2007.09.011.

This study focuses on the amosite mining region in South Africa and associated health effects, compared to other mined asbestos fiber types. Historically, dust and fiber levels were high in the amosite mills and mines, and many miners and members of the surrounding communities were exposed to the fibers. Research has shown that amosite produces both benign and malignant disease. Nevertheless, the mesotheliomagenic potential of amosite is several fold lower than crocidolite. The risk of disease associated with amosite exposure is difficult to quantify. Reasons for this include the scarcity of available information, including fiber measurements, and case ascertainment, as well as the juxtaposition of the amosite and crocidolite asbestos seams in South Africa.

Gamble vond in epidemiologische studies geen ondersteuning voor de hypothese dat asbestblootstelling het risico op maag-darmkanker vergroot. Bron: Gamble, J., (2007). Risk of gastrointestinal cancers from inhalation and ingestion of asbestos. Regul. Toxicol. Pharmacol., DOI:10.1016/j.yrtph.2007.10.009.

Gamble, J., (2007). Risk of gastrointestinal cancers from inhalation and ingestion of asbestos. Regul. Toxicol. Pharmacol., DOI:10.1016/j.yrtph.2007.10.009.

This paper summarizes the weight of epidemiological evidence to evaluate the hypothesis that asbestos exposure is causally associated with increased risk of gastrointestinal (GI) cancers as suggested by Selikoff in an early study of insulation workers. This review looks at populations that develop GI cancers, namely stomach, colorectal, colon and rectal. Guidelines for assessing causality are strength of association, biological gradient and consistency of the associations. Exposure-response (E-R) was evaluated using three methods to estimate exposure. Rate Ratios (RRs) for lung cancer and percent of mesothelioma are used as surrogate measures of asbestos exposure for all the cohorts of exposed workers. Quantitative or semi-quantitative estimates of cumulative exposure to asbestos were also used to assess E-R trends and were compared to E-R trends for lung cancer and mesothelioma in individual studies. Surrogate measures are important since there are few individual studies that have assessed E-R. None of the various methods to estimate asbestos exposure yielded consistent E-R trends and the strength of the associations were consistently weak or non-existent for the four types of GI cancers. The epidemiological evidence detracts from the hypothesis that occupational asbestos exposure increases the risk of stomach, colorectal, colon, and rectal cancer.

De tijd tussen het eerste moment van asbestblootstelling en het moment waarop de ziekte mesothelioom wordt vastgesteld wordt steeds langer en is nu al gemiddeld 45 jaar. Bij werkgerelateerde blootstelling is de latentietijd gemiddeld korter dan bij mensen die via asbest in het milieu de ziekte opgelopen hebben. Dit concluderen Italiaanse onderzoekers na analyse van gegevens van 2544 patiënten die tussen 1993 en 2001 mesothelioom kregen. Bron: Marinaccio, A. et al.,(2007). Analysis of latency time and its determinants in asbestos related malignant mesothelioma cases of the Italian register. European Journal of Cancer. Dec.43(18):2722-8.

Marinaccio, A. et al.,(2007). Analysis of latency time and its determinants in asbestos related malignant mesothelioma cases of the Italian register. European Journal of Cancer. Dec.43(18):2722-8.

Italy was an important producer of raw asbestos until 1992 (when it was banned) and it is now experiencing severe public health consequences due to large-scale industrial use of asbestos in shipbuilding and repair, asbestos-cement production, railways, buildings, chemicals and many other industrial sectors. Latency of malignant mesothelioma generally shows a large variability and the relationship with the modality of asbestos exposure is still not fully clarified. We present an analysis of latency period among the case list collected by the Italian mesothelioma register (ReNaM) in the period of diagnosis 1993-2001 (2544 malignant mesothelioma (MM) cases with asbestos exposure history). Exposure is assessed retrospectively by interview. Statistical univariate analyses were performed to estimate median and variability measures of latency time by anatomical site, gender and diagnosis period. The role of diagnostic confidence level, the morphology of the tumour and the modalities of asbestos exposure were verified in a regression multivariate model. We found a median latency period of 44.6 years increasing in recent years with a linear trend. Anatomical site, gender and morphology were not relevant for MM latency time whereas a shorter latency period was documented among occupationally exposed subjects (43 years) with respect to environmentally and household exposed ones (48 years).

Sinds 1 januari dit jaar kunnen alle Australische asbestslachtoffers met de ziekte mesothelioom chemotherapeutische behandeling met het dure medicijn Alimta vergoed krijgen. Deze behandeling kost in Australië 20.000 Australische dollar per kuur (ca. 12.500 euro). In Australië worden jaarlijks ca. 600 gevallen van mesothelioom geregistreerd. Bron: Canberra Times, 1 januari 2008.

Bronchoalveolaire lavage (BAL) is te riskant en waarschijnlijk onvoldoende effectief voor het asbestarm maken van de luchtwegen. Dit meldt het Nederlands Centrum voor Beroepsziekten (NCVB) in verband met twee medewerkers die enkele dagen asbestvezels hadden ingeademd tijdens onderhoudstimmerwerk. BAL is een methode om de luchtwegen schoon te maken. Bron: NCVB nieuwsbrief, december 2007. Meer http://www.beroepsziekten.nl/