Mezoteliom

Općenito

uzork

azbest

vlakna

pleura

fagocitoza

plakkarinoza

simian 40

genske predispozicije

latencija

20 do 40 godina

puno genskih mutacija

incidencija

M2, Ž0.7na 10na5

Dijagnoza

biopsija

punkcija neg

zadebljanja pleure

perkusija muklina

Terapija

operabilni

st I

inop

modusi

centri izvrsnosti

malo bolesnika

pl izljev

th opcije

torakocenteza

talkaža

torakalni dren

praćenje

nekoliko mjeseci

nekoliko godina

PHD

epiteloidni

sarkomatoidni

bifazični

p16, p14, NF2

70-80%

rizik 20%

pušenje NE

gdje raste: 3P, tv testisa

razlika US vs zemlje razvoja

US pad

MS 4-10 mj

loša prognoza

4EORTC

Y, KS, WBC<8, sarko

markeri >80-SRMP, ostepoetin

simptomi

bol

nepleur bol

prisutan

rek izljev

pl zadebljanje

cito 23% poz

lokalna smrt

Algoritmi

postop RT

studije

Harvard retrospektiva, CAP (cytoaxa, Adr/cis)+RT+adj kemoth, MS 19 mj

MSKCC

triala

click to edit

Rusch, MSKCC, f2, MS 34 mj st I-II, kasniji stadiji 10 mj

ESMO

https://watermark.silverchair.com/mdv199.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAbAwggGsBgkqhkiG9w0BBwagggGdMIIBmQIBADCCAZIGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM8n54EFjshQGJWneeAgEQgIIBY1OorBlMQi2vJOrvhGzQeHFpfGyGw-r6Sxz5-XC8LHpNADJVwHdOxF1Db6h9tKizK0hhrQBJe1eWCsn-GQqaHfnwq_0QgdENJRmu2_jMnWV2Szk6wgt_yLI8lDrHuaExMZjs5v8lhs_SjmdzPU59TzXDe6ZgsYA-0p-jXonlcMxtsuc2wsq7KJLjIZpHbik813zj9cR34JpydwKaTlxgf-lzhJZw0v89bX6ytlMiyJYu6YvvvPzSkYLgEDdE21MNiTw3WEk22YsvQXZoub6ko8lnMJL9z65yDRODetqeopSVGMWM0LDvkX6UJyHqKKM_wGIibJu7RYL6JAPEX7oceNmkazagky5MSgbw6547wcwzlML7MbgCBzOFj_CZPSG0wZnpySoY7SgAjOGEaKTgmiB8LziRXXOKeYU0jy_7hUpU44ncmYtDXyeh7s5Oi6G3NM-Y2HxPH_zsDlAGnp1fq0B-ZYk

NCCN

https://www.nccn.org/professionals/physician_gls/pdf/mpm.pdf

shema

https://www.google.ba/search?q=mesothelioma+paradigm&source=lnms&tbm=isch&sa=X&ved=0ahUKEwim6uOO8uvaAhVjCZoKHWA_ANAQ_AUICigB&biw=1229&bih=587#imgrc=lvhe6Gwhx_dixM:

vrste

EPP

2P, lung plis LČ, diapfragma

<5%

smrtnost4-30%

OS 4-20 mj

P/D

kod uznpredovale (lokalne invazije, LČ)

smrtnost 5%

pal RT

doza 0-40Gy

RT na područje drena

bez smanjenja lokalne invazije kontamncijom s RT

sistemska

stanica

kemoth

Vogelzang, 12.9 vs 9.0, HR 0.74, 226 pts

Vino

Peme

VGFR

beva

MAPS

rezultati

https://www.google.ba/search?biw=1229&bih=587&tbm=isch&sa=1&ei=1ornWty5MYaOmgXQxJOIBg&q=maps+trial+mesothelioma&oq=maps+trial+mesothelioma&gs_l=psy-ab.3...1406.7110.0.7212.13.13.0.0.0.0.330.1820.2j6j2j1.11.0....0...1c.1.64.psy-ab..2.0.0....0.vMT5seEQXI8#imgrc=epR5BsOKNZD0iM:

Peme (ako nije bio u 1L)

Vino

gem

samo IT

PDL1+CTL4 2L

2L Nivo+Ipi

MAPS2

dizajn

rezultati

https://www.google.ba/search?q=maps+2+mesothelioma&source=lnms&tbm=isch&sa=X&ved=0ahUKEwihoea8-eLaAhXDlCwKHcJRAHgQ_AUICigB&biw=1229&bih=587#imgrc=w1wszwAdqPpGdM:

https://www.google.ba/search?q=maps+2+mesothelioma&source=lnms&tbm=isch&sa=X&ved=0ahUKEwihoea8-eLaAhXDlCwKHcJRAHgQ_AUICigB&biw=1229&bih=587#imgrc=B29q1E_7oIODwM:

Pembro

KN028

klinička slika

loklni simptomi

PLAN LIJEČENJA

https://www.google.com/search?biw=1218&bih=582&tbm=isch&sa=1&ei=naZYXKGAPczmrgSIuISYCg&q=malignant+pleural+mesothelioma+therapy&oq=malignant+pleural+mesothelioma+therapy&gs_l=img.3...1556.6327..7010...0.0..0.287.1413.3j2j3......1....1..gws-wiz-img.......0i30.30IDnbEiQ3I#imgrc=QZHsXvaNjvvUuM:

preuzmi

preuzmi (1)

preuzmi (2)

INITIATE

mOS 13mj

preuzmi (3)

mOS 11mj

Durva+Tremelimumab - NIBIT-MESO

dizajn

https://www.google.com/search?q=NIBIT-MESO-1+trial&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjNiaXt4a7gAhWF-ioKHUUxCy0Q_AUIDigB&biw=1218&bih=582#imgrc=2R0q8VpW8c1ZdM:

preuzmi (4)

mOS 16.6mj

mono

PROMISI u tijeku

mono

CONFIRM u tijeku

CM 743 N+I vs KT

CTL4

Magistra vitae

f2 + f3 - 2L

f2 MESOT-TREM + 52%kontrola bolesti

f3 DETERMINE OS -

preuzmi (5)

IT+KTvsKT

Durva

https://www.sciencedaily.com/releases/2020/06/200611152457.htm