At the 14th Conference of the International Mesothelioma Interest Group (iMig) in Ottawa, Canada, this May, mesothelioma research was presented in a number of plenary sessions and dozens of mini-symposiums. The topics of the sessions ranged from mesothelioma immunotherapy and surgery to imaging and biomarkers. Many advances in the study and diagnosis of the pleural mesothelioma tumor were presented to the gathering of mesothelioma researchers.
During these topical sessions, dozens of scientific studies were presented, showing the vibrant state of mesothelioma science. Kazan Law, which sponsors Mesothelioma Circle, is proud to be Gold Sponsor of the iMig 2018 conference. The law firm, which has represented mesothelioma patients since 1974, has provided funding for several ground-breaking studies through its foundation, the Kazan McClain Partners’ Foundation.
One of the mesothelioma research projects reported on was funded in part by a grant to the University of Chicago from a Kazan Law client and the Kazan McClain Partners Foundation Inc. The abstract, MS03.05: Deep Learning Applied to the Segmentation of Malignant Pleural Mesothelioma Tumor on Computer Tomography Scans, modeled a new way to improve the staging of the pleural mesothelioma tumor. The innovative approach could help doctors track tumor progression to better understand the most common form of mesothelioma.
Physics and Computer Science Applied to Mesothelioma Research
Study of the pleural mesothelioma tumor isn’t only conducted by medical doctors. Eyjolfur Gudmundsson, a physicist and computer scientist, led a team from the University of Chicago and the University of Australia in a study that applied computer learning to staging the pleural mesothelioma tumor.
This study investigated whether a computer could learn to read the CT scan (short for computed tomography) of a patient with a pleural mesothelioma tumor as well as a trained human. The scientists used deep convolutional neural networks (CNNs), a type of machine learning, to see if the artificial intelligence could learn to interpret the CT scan accurately.
CT scans are used to look at cross sections of the chest cavity of mesothelioma patients. Radiologists with experience working with malignant pleural mesothelioma patients can tell the difference between healthy tissue and a thickening of the pleura (the lining around the lungs) caused by a pleural mesothelioma tumor. The amount of thickening gives an idea of the volume of the tumor, in addition to its location.
Doctors may use CT scans during mesothelioma diagnosis, to determine the location and size of the tumor. A CT scan takes X-rays from many different angles. These images are combined to create a 3D image of the chest of a pleural mesothelioma patient. This 3D image can be sliced to examine cross sections of the tumor area.
The University of Chicago scientists asked an expert radiologist to review the cross sections for the CT scans of 69 mesothelioma patients. They then fed 67 scans to the CNN, so it could learn based on the work of the radiologist. The CNN used 2968 axial sections of CT scans for this training.
At the end of the training, the mesothelioma research team gave the CNN the two remaining CT scans, to see if it had learned to assess the volume of a pleural mesothelioma tumor as well as a human. The experiment was a success: the computer was a very close match to the human.
Because of the large number of axial sections in each CT scan, the use of a CNN can help doctors get test results more quickly and lower the cost of the examination. A 2013 study, using the CT scans of patients with non-small cell lung cancer, showed that a different tool (a program called 3D-Slicer) was even more accurate than humans at assessing the volumes of tumors.
Understanding Mesothelioma Progression
It’s important for doctors to monitor the volume of your pleural mesothelioma tumor because that gives them an idea about the progression of the disease. Because there is currently no cure for mesothelioma, the goal of mesothelioma treatments is to reduce the size of the tumor, or at least keep it from growing.
Keeping tabs on the growth of a pleural mesothelioma tumor can help your doctor understand whether a particular treatment is working. If a particular combination of chemotherapy drugs makes your tumor shrink and you can tolerate the treatment, that’s a good therapy for you.
A pleural mesothelioma tumor may, at some point, become resistant to a particular treatment. At that point, the tumor might start to grow, even during treatment. This is a sign that it’s time to switch to a different treatment option. Imaging tests like CT scans are an important tool to help assess the effectiveness of mesothelioma therapies.
With the advent of immunotherapy, mesothelioma patients have more treatment options. Because immunotherapy works very well for some patients and not for others, it’s more important than ever to track tumor progression during treatment.
An accurate picture of the volume of a pleural mesothelioma tumor can also help doctors determine the stage of the disease. Your mesothelioma stage is the amount the cancer had progressed by the time you were diagnosed and started treatment, even though the disease may advance after that. The earlier the stage at diagnosis, the more mesothelioma treatment options will be available to you.
The system for staging mesothelioma is called TNM. This stands for tumor, node, and metastasis. Each stage is broken down into additional sub-stages (T0, T1, T2, etc.). In the T stage, the cancer is confined to the original tumor site. In the N stage, mesothelioma has spread to nearby lymph nodes. In the M stage, cancer cells have migrated to other parts of the body or metastasized.
The iMig conference had a role in creating the staging system for mesothelioma: the TNM system was developed at one of its early gatherings.
No matter what stage mesothelioma is at diagnosis, almost every pleural mesothelioma tumor will likely begin to grow unchecked at some point. Immunotherapy appears to repress this deadly cancer in some patients for a longer period of time. It’s too soon to tell if this is the first step to a cure for mesothelioma.
iMig Fosters Collaboration in Mesothelioma Research
This University of Chicago study of a pioneering method to read the CT scan for a pleural mesothelioma tumor is a great example of the kind of cross pollination that the iMig organization encourages. The group was founded to improve communication and collaboration among the community of mesothelioma researchers scattered across the globe.
This year’s iMig conference shows the richness of that research. The organization has to take some of the credit for creating the environment in which major advances in the treatment of pleural mesothelioma tumors can occur. Kazan Law is proud to support this worthy effort.