Brigham System - Mesothelioma Staging Systems
Staging is one of the most important steps in a mesothelioma diagnosis because it has the biggest influence on treatment and overall prognosis. Several staging systems exist for mesothelioma cancer, and the Brigham staging system is used infrequently because it focuses on surgical candidacy. Because most mesothelioma patients are not candidates for aggressive surgery, this staging system is utilized for a limited number of cases.
The Brigham system was established by a team at Brigham and Women's Hospital, led by mesothelioma expert Dr. David Sugarbaker. In the early 1990s, following successful multimodal treatment results that included the implementation of the extrapleural pneumonectomy (EPP) surgery, researchers at the hospital were encouraged to create a new staging system that was predictive for patients who would qualify and benefit from surgical resection.
Previous staging systems measured the extent of metastasis, but the Brigham system indicated metastasis in addition to whether surgical resection of tumors was an option for patients. The Brigham system is limited to stage pleural mesothelioma and it is seldom used by doctors because most patients are diagnosed when surgery is no longer an option.
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Stages of the Brigham System
The Brigham system consists of four stages, each of which considers two variables: surgical resection of tumors and removal of affected lymph nodes. The four stages are:
Stage I
- Cancerous tumors are removable with surgery and there is no sign of metastasis into the nearby lymph nodes.
Stage II
- Tumor masses developing in the pleura have exceeded beyond the pleural envelope and are still removable through surgery. Lymph node metastasis has also occurred.
Stage III
- Surgery is no longer an option because metastasis has occurred in the chest wall, heart, diaphragm or lining of the abdomen.
Stage IV
- Distant or excessive metastasis has occurred and surgery is not an option.
This surgically based staging system can be used to identify patients who benefit from receiving an extrapleural pneumonectomy followed by chemotherapy and/or radiation.
In a study of 31 patients with stage I pleural mesothelioma according to the Brigham system, two-year and five-year survival rates were 68 percent and 46 percent, respectively, following recommended surgery and other treatment.
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