The Stages of Malignant Mesothelioma
In 1996, Sugarbaker and associates from the Brigham and Women’s Hospital and Dana-Farber Cancer Institute (Boston, MA) proposed the Brigham staging system based on tumor resectability, histology and nodal status, and uses a variety of diagnostic imaging technology such as the use of magnetic resonance imaging to assess transdiaphragmic and mediastinal invasion, and includes new methods for detecting lymph node metastases, including positron-emission tomography scanning, combined with mediastinoscopy, laparoscopy, and throracoscopy, for more accurate presectioning staging. This system was validated in a clinical trial performed by Sugarbaker, and associates from 1980-1995.
This staging system made an impact on the treatment of mesothelioma because of its triple approach of combining chemotherapy and radiation after extensive surgical resectioning. In its time, this staging method was also heralded for its use of computer axial tomography and magnetic resonance imaging scans in an effective manner to assist in the diagnosis, establising prognosis and providing effective means of treatment for mesothelioma patients.
With the advent of the International TNM system, use of the Brigham System diminished, due to its assertion that lymph node involvement does not play a role in determining survival rate for patients. Most within the medical community rejected this idea, and turned to the TNM system which takes into consideration lymph node involvement, which is known to play an important role in providing a more accurate prognosis for patients, by evaluation the N2, of mediastinal lymph nodes involvement in placing a tumor into a Stage III instead of a Stage II. Since lymph node involvement of this nature can be fatal, and the Brigham System does not take this into consideration, the TNM System is more widely adopted to date.
Below is a review of the Brigham System’s staging criteria:
Stage I: Resectable Mesothelioma and no lymph node involvement
Stage II: Resectable Mesothelioma but with lymph node involvement
Stage III: Unresectable Mesothelioma extending into chest wall, heart, or through diaphragm, peritoneum; with or without extrathoracic lymph node involvement
Stage IV: Distant metastatic disease