Is There a Better Way for Doctors to Evaluate a Mesothelioma Patient’s Response to Treatment?

Treatment & Doctors
Reading Time: 3 mins
Publication Date: 10/24/2012
Fact Checked
Our fact-checking process begins with a thorough review of all sources to ensure they are high quality. Then we cross-check the facts with original medical or scientific reports published by those sources, or we validate the facts with reputable news organizations, medical and scientific experts and other health experts. Each page includes all sources for full transparency.
Reviewed is the nation’s most trusted mesothelioma resource

The Mesothelioma Center at has provided patients and their loved ones the most updated and reliable information on mesothelioma and asbestos exposure since 2006.

Our team of Patient Advocates includes a medical doctor, a registered nurse, health services administrators, veterans, VA-accredited Claims Agents, an oncology patient navigator and hospice care expert. Their combined expertise means we help any mesothelioma patient or loved one through every step of their cancer journey.

More than 30 contributors, including mesothelioma doctors, survivors, health care professionals and other experts, have peer-reviewed our website and written unique research-driven articles to ensure you get the highest-quality medical and health information.

About The Mesothelioma Center at

  • Assisting mesothelioma patients and their loved ones since 2006.
  • Helps more than 50% of mesothelioma patients diagnosed annually in the U.S.
  • A+ rating from the Better Business Bureau.
  • 5-star reviewed mesothelioma and support organization.
Learn More About Us


"My family has only the highest compliment for the assistance and support that we received from The Mesothelioma Center. This is a staff of compassionate and knowledgeable individuals who respect what your family is experiencing and who go the extra mile to make an unfortunate diagnosis less stressful. Information and assistance were provided by The Mesothelioma Center at no cost to our family."
Mesothelioma patient’s daughter
  • Google Review Rating
  • BBB Review Rating

How to Cite’s Article


Franz, F. (2020, October 16). Is There a Better Way for Doctors to Evaluate a Mesothelioma Patient’s Response to Treatment? Retrieved October 6, 2022, from


Franz, Faith. "Is There a Better Way for Doctors to Evaluate a Mesothelioma Patient’s Response to Treatment?", 16 Oct 2020,


Franz, Faith. "Is There a Better Way for Doctors to Evaluate a Mesothelioma Patient’s Response to Treatment?" Last modified October 16, 2020.

In June 2012, a graduate student named Zacariah Labby submitted his doctoral dissertation to the Committee on Medical Physics at the University of Chicago’s Pritzker School of Medicine.

For the past five years, he had worked under world-renowned mesothelioma experts Dr. Samuel Armato and Dr. Hedy Lee Kindler. While studying mesothelioma response evaluation models, he noticed a big problem.

Some patients who doctors thought were getting better passed away before patients whose disease was progressing.

This led Labby to believe that current criteria may not accurately determine a mesothelioma patient’s response. Doctors may accidentally misclassify stable tumors as progressive, unnecessarily limiting the patient’s treatment options.

Labby then launched a study to optimize the classification criteria. He rearranged patients in categories until there was an improved correlation between image-based response and patient survival.

Based on his optimized criteria, just over 22 percent of the patients in Labby’s study were originally misclassified.

His findings will appear in the November issue of the Journal of Thoracic Oncology.

Problems with the Current Mesothelioma Evaluation Models

Most doctors use CT scans to evaluate a mesothelioma tumor’s response to treatment.

They also measure the thickness of the tumor, then classify patients as having either responsive, stable or progressive disease.

The standard rules say that if a tumor decreases by more than 30 percent, the patient has a partial response. If the tumor increases by 20 percent or more, it is considered progressive disease.

Unfortunately, not all mesothelioma patients fit this model.

Standard criteria were developed to apply to all solid tumors. As Labby’s team pointed out, there are no specific considerations for the unique growth pattern of mesothelioma.

Mesothelioma tumors often overlap with the muscles in the adjacent chest wall. This makes it difficult for doctors to correctly identify the boundaries of the tumor.

Additionally, pleural effusions – fluid buildups that affect up to 90 percent of mesothelioma patients – can look like cancerous tissue on a CT scan.

“There is room for doubt on the applicability of such criteria for classification of response in a disease so typically aspherical as mesothelioma,” Labby wrote in his dissertation.

Tailoring Response Criteria to Mesothelioma Patients

To develop mesothelioma-specific criteria, Labby studied a cohort of 78 pleural mesothelioma patients receiving chemotherapy at Sir Charles Gairdner Hospital in Western Australia.

Doctors took between two and five CT scans of each patient throughout their treatment. On average, they measured the tumor response every 45 days. Researchers also collected final survival data.

Labby adjusted the response criteria in 1 percent increments until all patients in the group had a survival rate that matched their classification. He determined that the standard criteria misclassified 17 patients.

Labby believed that some of the patients in his study could have qualified for clinical trials if classified under his criteria. Both of the patients who were considered to have progressive disease under standard criteria were reclassified as having stable disease under Labby’s optimized criteria.

Misclassified patients may miss out on potentially lifesaving treatments. Some may not qualify for standard therapies, while others may miss the cutoff for clinical trials.

“These techniques will hopefully impact the tools clinicians use to assess patient response in both phase II clinical trials and routine patient care,” explained Labby in his dissertation.

Medically Reviewed by Top Mesothelioma Doctors
Free Mesothelioma Guide