Asbestos related pleural disease

  • Duneesha De Fonseka

Student thesis: Doctoral ThesisDoctor of Philosophy (PhD)

Abstract

Introduction
Asbestos exposure is known to cause a number of pleural pathologies. Despite a ban of asbestos use over 30 years ago, the incidence of asbestos related pleural disease continues to increase due to the prolonged lag period from exposure to disease development. In this thesis I explore a number of gaps in the literature relating to asbestos related benign and malignant pleural pathology.

Methods
The first study is a prospective case series of diffuse pleural thickening. Full respiratory function of patients with different distributions of pleural thickening on CT were compared against a matched control population. The results confirm a significant reduction in lung function in patients with all forms of diffuse pleural thickening by size criteria, including those with no costo-phrenic angle involvement.
The second study assesses the role of MRI as an exploratory tool in those with equivocal pleural thickening on CT. Early differentiation of malignant from benign pleural thickening is crucial to offer patients the best clinical management. MRI was investigated as a potential non-invasive method of diagnosing patients with equivocal CT findings.
The third study is a multi-centre randomised controlled study (RCT) to investigate whether a Positron Emission Tomography (PET)-CT targeted biopsy is superior to a standard CT guided biopsy, for patients with suspected pleural malignancy, who have had one non-diagnostic biopsy. 52 patients have been recruited to date and the trial will finish recruitment in September 2018.
The fourth study is a multi-centre RCT investigating the feasibility of delivering zoledronic acid or placebo concurrently with chemotherapy for patients with Mesothelioma. Whilst we did not meet our primary feasibility outcome of randomising 50 patients across 3 sites in 13 months, we did obtain valuable information that would help us in designing a full phase-III trial.
The final study is a prospective cohort study investigating the role of serial mesothelin biomarker monitoring of patients with MPM, who are receiving best supportive care. A 10% rise in mesothelin can reliably predict progressive disease.
Discussion
The findings discussed as a part of this thesis add to our current knowledge on asbestos related pleural disease and hopefully will inform clinicians managing patients with asbestos related pleural disease.
Date of Award25 Jun 2019
Original languageEnglish
Awarding Institution
  • The University of Bristol
SupervisorNick A Maskell (Supervisor)

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