Mesothelioma: Hillerdal G

van Meerbeeck JP, Hillerdal G. · No affiliation provided · Am J Respir Crit Care Med. · Pubmed #18832552 No free full text.

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Hillerdal G. · Department of Lung Medicine, Karolinska Hospital, Stockholm, Sweden. · Occup Environ Med. · Pubmed #10492646 links to  free full text

Abstract: OBJECTIVES: To estimate the importance of low dose exposure to asbestos on the risk of mesothelioma. METHODS: A review of the literature. RESULTS AND CONCLUSIONS: There is no evidence of a threshold level below which there is no risk of mesothelioma. Low level exposure more often than not contains peak concentrations which can be very high for short periods. There might exist a background level of mesothelioma occurring in the absence of exposure ot asbestos, but there is no proof of this and this "natural level" is probably much lower than the 1-2/million/year which has been often cited.

Hillerdal G, Sorensen JB, Sundström S, Riska H, Vikström A, Hjerpe A. · Department of Lung Medicine and Allergology, Karolinska University Hospital, Solna, Stockholm, Sweden. · J Thorac Oncol. · Pubmed #18978569 No free full text.

Abstract: BACKGROUND: Malignant pleural mesothelioma has a poor prognosis and there is limited effect of treatment. The Nordic Mesothelioma groups decided in the year 2000 to investigate a combination of liposomized doxorubicin, carboplatin, and gemcitabine for this disease in a phase II study. METHODS: From January 2001, to December 2003, 173 evaluable patients with biopsy-verified malignant mesothelioma were included. Two patients were lost to follow-up, but all the others were followed for at least 4 years or until death. RESULTS: Toxicity was fairly low. There were 56 responses (32.4%), of which 2 were complete; the median time to progression was 8.6 months, and the median overall survival was 13 months. Some patients had their responses 4 to 6 months after last treatment. For 116 patients with epitheloid subtype, median survival was 17 months. A subgroup of these patients with good performance status, early stage, and age 70 years or less, showed a median survival of 22 months. CONCLUSION: The treatment yields good results with a high number of responses and long survival, and a low toxicity. The long survival of the epitheloid subgroup with good prognostic factors is as good as or even better than some studies on "radical" surgery or multimodal treatment, underlining the need of randomized studies to evaluate such treatment options.

Hillerdal G, Elmberger G. · Department of Lung Medicine, Karolinska University Hospital, Stockholm, Sweden. · J Thorac Oncol. · Pubmed #17909365 No free full text.

Abstract: Mesothelioma can occur in different variants, some of which are difficult or impossible to differentiate from sarcomas. There are scattered reports of sarcomatous mesotheliomas that have osteogenic properties. Here, we report a 57-year old man who presented with a mediastinal tumor containing scattered irregular calcifications with some scattered pleural thickening of the right pleura. Biopsy showed a sarcoma with bone formation. The man was born in the Turkish village of Karain, where the incidence of mesothelioma is extremely high, and a sarcomatous mesothelioma was therefore diagnosed. Since the tumor was pressing against the large vessels and heart, a debulking was performed, followed by Pemetrexed and Carboplatin treatment. However, the tumor grew rapidly and spread to the pleura, involved the heart, and the patient succumbed. This is to our knowledge the first report of a sarcomatous mesothelioma with bone formation from environmental exposure to mineral fibers.

Byrne M, Hillerdal G. · Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, WA 6009, Australia. · Lung Cancer. · Pubmed #15950795 No free full text.

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Hillerdal G. · Department of Lung Medicine, Karolinska Hospital, Stockholm, Sweden. · Lung Cancer. · Pubmed #14698540 No free full text.

This publication has no abstract.

Metintas M, Ucgun I, Elbek O, Erginel S, Metintas S, Kolsuz M, Harmanci E, Alatas F, Hillerdal G, Ozkan R, Kaya T. · Department of Chest Diseases, Osmangazi University Medical Faculty, Eskişehir, Turkey. · Eur J Radiol. · Pubmed #11750145 No free full text.

Abstract: OBJECTIVE: To investigate the computed tomography (CT) features of malignant pleural mesothelioma (MPM) cases, comparing them to those in other malignant and benign pleural diseases. MATERIALS AND METHODS: We reviewed the CT findings of 215 patients; 99 with MPM, 39 with metastatic pleural disease (MPD), and 77 with benign pleural disease. The findings were evaluated in univariate and multivariate analysis for differentiation of pleural diseases. RESULTS: In patients with MPM, the most common CT features were circumferential lung encasement by multiple nodules (28%); pleural thickening with irregular pleuropulmonary margins (26%); and pleural thickening with superimposed nodules (20%). In the majority (70%) of cases, there was rind-like extension of tumor on the pleural surfaces. In multivariate analysis, the CT findings of "rind-like pleural involvement", "mediastinal pleural involvement", and "pleural thickness more than 1 cm" were independent findings in differentiating MPM from MPD with the sensitivity/specificity values of 70/85, 85/67, and 59/82, respectively. "Rind-like pleural involvement", "mediastinal pleural involvement", "pleural nodularity" and "pleural thickness more than 1 cm" were independent findings for differentiation of malignant pleural diseases (MPM+MPD) from benign pleural disease with the sensitivity/specificity values of 54/95, 70/83, 38/96, and 47/64, respectively. Invasion of thoracic structures such as pericardium, chest wall, diaphragm, mediastinum, with pleural disease and nodular involvement of fissures, was detected infrequently; however, since these invasions were not seen in benign pleural diseases, it was concluded these invasions, if detected on a CT scan, directly suggested malignancy. CONCLUSION: A patient has extremely high probability of malignant pleural disease if one or more of these CT findings are found and the possibility of MPM is high. These findings may be important for patients in bad state or patients who do not want any invasive biopsy procedures. It is also possible to identify cases with a low probability of malignant disease.

Metintas M, Ozdemir N, Hillerdal G, Uçgun I, Metintas S, Baykul C, Elbek O, Mutlu S, Kolsuz M. · Department of Chest Disease, Osmangazi University Medical Faculty, Eskişehir, Turkey. · Respir Med. · Pubmed #10464903 No free full text.

Abstract: Asbestos-related benign and malignant pleural diseases are endemic in some rural parts of central Turkey because of environmental exposure to asbestos fibres. We report here epidemiological data on 113 patients with diffuse malignant pleural mesothelioma (DMPM) diagnosed in our clinic in Eskişehir, located in central Turkey. Of the 113 patients, 59 were men and 54 women (male:female ratio = 1). Ninety-seven patients (86%) had non-occupational asbestos exposure; all were living in villages. Their mean age was 56 years. As the patients had been exposed to asbestos from birth, the latency period was equivalent to the age of the patients. Twenty-eight patients (29%) had lived in villages their entire lives. The other 69 (71%) had been born in a village but migrated to the city or had given up white-soil usage for various reasons. The mean exposure time was 55 years for those with a long exposure period and 25 years for those with a short exposure period, but there was no significant difference between the age of the disease appearance for both groups (55 and 56 years, respectively). Thus, the latency time of mesothelioma due to environmental exposure to asbestos was longer than that due to occupational exposure, but independent of the length of exposure. Soil samples from 67 villages were analysed, comprising a population of 10,120 villagers. Tremolite and some other types of asbestos were found. In conclusion, DMPM in our region is due to mainly to environmental exposure to asbestos. The risk is substantial as a large proportion of the villagers are exposed. After smoking, asbestos exposure is one of the most serious health hazards in our rural population.

Metintas M, Hillerdal G, Metintas S. · Dept of Chest Diseases, Medical School of Osmangazi University, Eskisehir, Turkey. · Eur Respir J. · Pubmed #10232420 links to  free full text

Abstract: The incidence of malignant mesothelioma is extremely high in some Turkish villages where there is a low-level environmental exposure to erionite, a fibrous zeolite. The best known example is the village of Karain. However, since epidemiological studies are difficult to perform in Turkey, the incidence and the dose-response curve have not been thoroughly examined. A small cohort of immigrants from Karain who have lived in Sweden for many years were studied. Exposure data, i.e. the time residing in Karain, and hospital records including pathological diagnosis, were recorded. The cohort consisted of 162 people. During the observation time, 18 deaths occurred, 14 (78%) of which were due to malignant pleural mesothelioma. In addition, there were five patients with mesothelioma who were still alive, one of whom had a peritoneal mesothelioma. Thus, the risk of mesothelioma is 135-times and 1,336-times greater in males and females, respectively, than for the same sex and age groups in Sweden. The risk increased with duration of residence.

Carbone M, Albelda SM, Broaddus VC, Flores RM, Hillerdal G, Jaurand MC, Kjaerheim K, Pass HI, Robinson B, Tsao A. · Thoracic Oncology, Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI, USA. · Oncogene. · Pubmed #17496929 No free full text.

Abstract: The eighth International Mesothelioma Interest Group (IMIG) meeting was held in Chicago, IL, United States, in 19-22 October 2006 to discuss mesothelioma - the cancer often linked to asbestos exposure. It is a very aggressive malignancy with a median survival of less than 1 year from diagnosis. Millions of people have been exposed worldwide to asbestos, especially during the second half of the twentieth century when asbestos use increased significantly. The tons of asbestos utilized in the past remain a health hazard for current and future generations because asbestos is difficult to be disposed off. This makes asbestos and mesothelioma research a public health issue in addition to a medical problem. Moreover, the very high costs of asbestos litigation have a significant impact on the whole economy. In the United States, up until 2001, defendant companies had paid 54 billion dollars in claims and estimated future liabilities ranged from 145 to 210 billion. Therefore, asbestos research is of great interest to a large audience that includes patients, millions of asbestos-exposed individuals, scientists, physicians, public health officials, politicians, unions of asbestos workers, lawyers and the public at large. During the past few years, there has been significant progress in understanding the process of mineral fiber carcinogenesis and mesothelioma pathogenesis. With improved understanding of the pathogenesis of mesothelioma, new diagnostic, preventive and therapeutic options are being developed. A total of 247 papers were presented at the IMIG: the abstracts of these presentations were published in Lung Cancer, Supplement 1, October 2006. Here, experts in different disciplines critically review some of the most exciting presentations of the IMIG meeting. The result is a comprehensive review of the research field of asbestos carcinogenesis and mesothelioma, and of the progress that has been made in recent years in both basic and clinical sciences.