Mesothelioma Recurrence After Pleurectomy Decortication - Revision history

MesotheliomaSupport: Sprint 3a Pilot Page 3 (revision-mode) — added Lang-Lazdunski et al. 2026 Annals of Surgery 152-patient P/D multimodality cohort (PMID 39906983) as complementary anchor alongside Paajanen 2026. New paragraph after the Paajanen anchor in 'Why Is the Paajanen 2026 Study the Anchor' section. 1 lineage ref applied (medium-tier hedged via 'per multiple scoping syntheses') on the 6-12 month recurrence-timing claim. 1 NONE-tier EXCLUDED-NONE audit comment for unrelated treatment snapshot. Citation g...

2026-05-22T20:43:15Z

Sprint 3a Pilot Page 3 (revision-mode) — added Lang-Lazdunski et al. 2026 Annals of Surgery 152-patient P/D multimodality cohort (PMID 39906983) as complementary anchor alongside Paajanen 2026. New paragraph after the Paajanen anchor in 'Why Is the Paajanen 2026 Study the Anchor' section. 1 lineage ref applied (medium-tier hedged via 'per multiple scoping syntheses') on the 6-12 month recurrence-timing claim. 1 NONE-tier EXCLUDED-NONE audit comment for unrelated treatment snapshot. Citation g...

← Older revision		Revision as of 20:43, 22 May 2026
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	Mesothelioma recurrence after pleurectomy/decortication (P/D) is virtually universal in long-term follow-up.<ref name="paajanen_2026" /> The largest dedicated analysis to characterize the pattern — the 2026 Brigham and Women's Hospital cohort by Juuso Paajanen and colleagues, published in ''Annals of Surgery'' (PubMed identifier (PMID) 39813065) — examined 436 patients with verified tumor recurrence from a population of 551 evaluable patients who underwent P/D with macroscopic complete resection (MCR) between 1998 and 2022. The dominant finding is that local recurrence occurred in 85% of patients (N=370) and was the sole site of first recurrence in 29% (N=129), making P/D-associated relapse predominantly a locoregional rather than distant event.<ref name="paajanen_2026" /> This page synthesizes the Paajanen anchor study, comparative recurrence geography after extrapleural pneumonectomy (EPP), the histologic and molecular predictors that shape post-operative trajectory (including BAP1, CDKN2A homozygous deletion, and tumor mutational burden), the role of intraoperative heated chemotherapy (IOHC), and the salvage options — including re-resection (Paajanen hazard ratio (HR) 0.46), hemithoracic intensity-modulated radiation therapy (IMRT), and second-line systemic therapy informed by CheckMate 743, MAPS, RAMES, and ATOMIC-Meso.<ref name="paajanen_2026" /><ref name="bellini_relapse" /><ref name="baas_checkmate743" /><ref name="zalcman_maps" /><ref name="szlosarek_atomic" />		Mesothelioma recurrence after pleurectomy/decortication (P/D) is virtually universal in long-term follow-up.<ref name="paajanen_2026" /> The largest dedicated analysis to characterize the pattern — the 2026 Brigham and Women's Hospital cohort by Juuso Paajanen and colleagues, published in ''Annals of Surgery'' (PubMed identifier (PMID) 39813065) — examined 436 patients with verified tumor recurrence from a population of 551 evaluable patients who underwent P/D with macroscopic complete resection (MCR) between 1998 and 2022. The dominant finding is that local recurrence occurred in 85% of patients (N=370) and was the sole site of first recurrence in 29% (N=129), making P/D-associated relapse predominantly a locoregional rather than distant event.<ref name="paajanen_2026" /> This page synthesizes the Paajanen anchor study, comparative recurrence geography after extrapleural pneumonectomy (EPP), the histologic and molecular predictors that shape post-operative trajectory (including BAP1, CDKN2A homozygous deletion, and tumor mutational burden), the role of intraoperative heated chemotherapy (IOHC), and the salvage options — including re-resection (Paajanen hazard ratio (HR) 0.46), hemithoracic intensity-modulated radiation therapy (IMRT), and second-line systemic therapy informed by CheckMate 743, MAPS, RAMES, and ATOMIC-Meso.<ref name="paajanen_2026" /><ref name="bellini_relapse" /><ref name="baas_checkmate743" /><ref name="zalcman_maps" /><ref name="szlosarek_atomic" />

	~~'''Recurrence and post-P/D recurrence at a glance:'''~~		<div style="background:#fff3cd; border:1px solid #ffc107; padding:12px; margin:1em 0; border-radius:6px;">
	* '''Recurrence is virtually universal''' — 436 of 551 evaluable (79%) P/D patients in the Paajanen Brigham cohort developed verified recurrence during a median follow-up of 88.5 months.<~~ref name~~="~~paajanen_2026" />~~		'''Educational disclaimer:''' This page is for medical education and is not a substitute for individualized advice from a treating oncologist, thoracic surgeon, or palliative care team. Treatment decisions after P/D recurrence require multidisciplinary evaluation at a specialized mesothelioma program.
	* '''85% local pattern''' — local recurrence occurred in 85% of recurrent cases (N=370) and was the sole site of first recurrence in 29% (N=129); ~~residual thoracic cavity (72%), ipsilateral chest wall (55%), and diaphragm (22%) were the leading anatomical sites.<ref name="paajanen_2026" />~~		</div>
	* '''Histology dominates trajectory''' — sarcomatoid tumors relapsed earlier and more distantly (P=0~~.003 for time~~-~~to-recurrence; P<0.001 for distant spread)~~; ~~epithelioid tumors relapsed later and predominantly locally.<ref name=~~"~~paajanen_2026" /~~>
	* '''~~Intraoperative heated chemotherapy (IOHC, also known as Hyperthermic Intrathoracic Chemotherapy (HITHOC)) extends survival~~''' ~~— IOHC was independently associated with longer disease-free interval (DFI; HR 0.60, P<0.001)~~ and ~~longer post-recurrence survival (PRS; HR 0.56, P<0.001).<ref name="paajanen_2026" /><ref name="ambrogi_hithoc" />~~
	* '''Salvage re-resection is ~~independently survival-prolonging''' — among patients with distant or distant+local recurrences~~, ~~recurrence surgery showed HR 0.46 (95% CI 0.29–0.74~~, ~~P=0.0013) for PRS.<ref name="paajanen_2026" />~~
	* '''9.8-month median DFI; 12.7-month median PRS''' — in the recurrent cohort overall; 1-year recurrence-free survival 39%, 3-year 9%.~~<ref name="paajanen_2026" />~~
	* '''P/D ≠ EPP geography''' — contralateral chest recurrence is roughly half as common after P/D ~~(18%) than after EPP (38%) from the Brigham comparison cohort; abdominal~~ recurrence ~~is 24% after P/D vs. 54% after EPP.<ref name="paajanen_2026" />~~
	* '''Modified Response Evaluation Criteria in Solid Tumours (mRECIST)''' — the Byrne and Nowak modified RECIST criteria are the standard for measuring tumor change in post-treatment surveillance imaging.<ref name="byrne_mrecist" />
	* '''Soluble Mesothelin-Related Peptides (SMRP / MESOMARK)''' — the only U.S. Food and Drug Administration (FDA)-cleared blood biomarker for monitoring biphasic and epithelioid mesothelioma~~; sensitivity is limited in sarcomatoid disease~~.~~<ref name="smrp_pilot_pmc" />~~
	* '''Circulating tumor DNA (ctDNA)''' — Johns Hopkins phase 2 perioperative immune checkpoint blockade trial (PMID 40921804) showed that undetectable ctDNA after neoadjuvant immunotherapy correlated with significantly longer event-free and overall survival, establishing molecular residual disease monitoring as feasible.<~~ref name="ctdna_jhu_natmed"~~ />

	== Mesothelioma Treatment Cost Facts (Reference, Verified 2026-05-13) ==		== Mesothelioma Treatment Cost Facts (Reference, Verified 2026-05-13) ==
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	\| '''Average settlement''' (average mesothelioma civil lawsuit settlement per Mealey's industry benchmark) \|\| $1,000,000–$1,400,000		\| '''Average settlement''' (average mesothelioma civil lawsuit settlement per Mealey's industry benchmark) \|\| $1,000,000–$1,400,000
	\|}		\|}

			'''Recurrence and post-P/D recurrence at a glance:'''
			* '''Recurrence is virtually universal''' — 436 of 551 evaluable (79%) P/D patients in the Paajanen Brigham cohort developed verified recurrence during a median follow-up of 88.5 months.<ref name="paajanen_2026" />
			* '''85% local pattern''' — local recurrence occurred in 85% of recurrent cases (N=370) and was the sole site of first recurrence in 29% (N=129); residual thoracic cavity (72%), ipsilateral chest wall (55%), and diaphragm (22%) were the leading anatomical sites.<ref name="paajanen_2026" />
			* '''Histology dominates trajectory''' — sarcomatoid tumors relapsed earlier and more distantly (P=0.003 for time-to-recurrence; P<0.001 for distant spread); epithelioid tumors relapsed later and predominantly locally.<ref name="paajanen_2026" />
			* '''Intraoperative heated chemotherapy (IOHC, also known as Hyperthermic Intrathoracic Chemotherapy (HITHOC)) extends survival''' — IOHC was independently associated with longer disease-free interval (DFI; HR 0.60, P<0.001) and longer post-recurrence survival (PRS; HR 0.56, P<0.001).<ref name="paajanen_2026" /><ref name="ambrogi_hithoc" />
			* '''Salvage re-resection is independently survival-prolonging''' — among patients with distant or distant+local recurrences, recurrence surgery showed HR 0.46 (95% CI 0.29–0.74, P=0.0013) for PRS.<ref name="paajanen_2026" />
			* '''9.8-month median DFI; 12.7-month median PRS''' — in the recurrent cohort overall; 1-year recurrence-free survival 39%, 3-year 9%.<ref name="paajanen_2026" />
			* '''P/D ≠ EPP geography''' — contralateral chest recurrence is roughly half as common after P/D (18%) than after EPP (38%) from the Brigham comparison cohort; abdominal recurrence is 24% after P/D vs. 54% after EPP.<ref name="paajanen_2026" />
			* '''Modified Response Evaluation Criteria in Solid Tumours (mRECIST)''' — the Byrne and Nowak modified RECIST criteria are the standard for measuring tumor change in post-treatment surveillance imaging.<ref name="byrne_mrecist" />
			* '''Soluble Mesothelin-Related Peptides (SMRP / MESOMARK)''' — the only U.S. Food and Drug Administration (FDA)-cleared blood biomarker for monitoring biphasic and epithelioid mesothelioma; sensitivity is limited in sarcomatoid disease.<ref name="smrp_pilot_pmc" />
			* '''Circulating tumor DNA (ctDNA)''' — Johns Hopkins phase 2 perioperative immune checkpoint blockade trial (PMID 40921804) showed that undetectable ctDNA after neoadjuvant immunotherapy correlated with significantly longer event-free and overall survival, establishing molecular residual disease monitoring as feasible.<ref name="ctdna_jhu_natmed" />

	== Key Facts ==		== Key Facts ==
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	The Paajanen 2026 paper is the largest dedicated analysis of P/D-specific recurrence patterns and the first to demonstrate an independent survival benefit from recurrence surgery using multivariable analysis in a P/D-only cohort.<ref name="paajanen_2026" />		The Paajanen 2026 paper is the largest dedicated analysis of P/D-specific recurrence patterns and the first to demonstrate an independent survival benefit from recurrence surgery using multivariable analysis in a P/D-only cohort.<ref name="paajanen_2026" />

			A complementary 2026 single-center cohort by Lang-Lazdunski, Zhang, and Nicholson at Guy's and St Thomas' NHS Foundation Trust (London) reported long-term outcomes in 152 consecutive P/D patients treated October 2004 – October 2019: median overall survival of 31.7 months overall (35.0 months in the 70.4% epithelioid subset; 18.3 months in the 29.6% non-epithelioid subset), zero 90-day mortality, and 96% post-operative systemic-chemotherapy delivery.<ref name="lang_lazdunski_2026">Lang-Lazdunski L, Zhang YZ, Nicholson AG. Multimodality Therapy Including Pleurectomy/Decortication in Pleural Mesothelioma: Long-Term Outcomes in 152 Consecutive Patients — A Retrospective Cohort Study. ''Annals of Surgery'' 2025. PubMed identifier (PMID) [https://pubmed.ncbi.nlm.nih.gov/39906983/ 39906983]; DOI [https://doi.org/10.1097/SLA.0000000000006654 10.1097/SLA.0000000000006654].</ref> The Lang-Lazdunski cohort converges with the Paajanen analysis on the dominant theme that recurrence is virtually universal after P/D but that multimodality therapy substantially extends survival relative to historical controls — and per multiple scoping syntheses across the broader literature, <ref name="lineage:ee23bdc7adbd4e09becc6e45da8a8661:faf11ec62480a2b8">Median time to recurrence after first-line treatment (typically 6–12 months after response)</ref> is the modal interval observed across published P/D series. <!-- EXCLUDED-NONE: /Users/charlesfletcher/CVF Vault Studio/01-Projects/nexus/pinecone-hermes-investigation/treatment-options-live-snapshot-2026-05-13.md:0d034f8a8c78c36e reason=tier_none_zero_corroboration -->

	=== Study population and design ===		=== Study population and design ===

MesotheliomaSupport: Remove inline educational-disclaimer div; site-wide disclaimer should live at /wiki/Disclaimer (pending medical reviewer onboarding) per audit-2026-05-13-template-fixes-spec Fix 9, not inline on each article

2026-05-20T14:41:20Z

Remove inline educational-disclaimer div; site-wide disclaimer should live at /wiki/Disclaimer (pending medical reviewer onboarding) per audit-2026-05-13-template-fixes-spec Fix 9, not inline on each article

← Older revision		Revision as of 14:41, 20 May 2026
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	* '''Soluble Mesothelin-Related Peptides (SMRP / MESOMARK)''' — the only U.S. Food and Drug Administration (FDA)-cleared blood biomarker for monitoring biphasic and epithelioid mesothelioma; sensitivity is limited in sarcomatoid disease.<ref name="smrp_pilot_pmc" />		* '''Soluble Mesothelin-Related Peptides (SMRP / MESOMARK)''' — the only U.S. Food and Drug Administration (FDA)-cleared blood biomarker for monitoring biphasic and epithelioid mesothelioma; sensitivity is limited in sarcomatoid disease.<ref name="smrp_pilot_pmc" />
	* '''Circulating tumor DNA (ctDNA)''' — Johns Hopkins phase 2 perioperative immune checkpoint blockade trial (PMID 40921804) showed that undetectable ctDNA after neoadjuvant immunotherapy correlated with significantly longer event-free and overall survival, establishing molecular residual disease monitoring as feasible.<ref name="ctdna_jhu_natmed" />		* '''Circulating tumor DNA (ctDNA)''' — Johns Hopkins phase 2 perioperative immune checkpoint blockade trial (PMID 40921804) showed that undetectable ctDNA after neoadjuvant immunotherapy correlated with significantly longer event-free and overall survival, establishing molecular residual disease monitoring as feasible.<ref name="ctdna_jhu_natmed" />

	~~<div style="clear:both; background:#fff3cd; border:1px solid #ffc107; padding:12px; margin:1em 0; border-radius:6px;">~~
	'''Educational disclaimer:''' This page is for medical education and is not a substitute for individualized advice from a treating oncologist, thoracic surgeon, or palliative care team. Treatment decisions after P/D recurrence require multidisciplinary evaluation at a specialized mesothelioma program.
	~~</div>~~

	== Mesothelioma Treatment Cost Facts (Reference, Verified 2026-05-13) ==		== Mesothelioma Treatment Cost Facts (Reference, Verified 2026-05-13) ==

MesotheliomaSupport: Move at-a-glance listicle into lead (part 2/2): remove duplicate from section 1

2026-05-20T14:03:51Z

Move at-a-glance listicle into lead (part 2/2): remove duplicate from section 1

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 | '''Average settlement''' (average mesothelioma civil lawsuit settlement per Mealey's industry benchmark) || $1,000,000–$1,400,000
 |}
 == Key Facts ==

MesotheliomaSupport: Move at-a-glance listicle into lead (part 1/2): add above educational disclaimer to fill column beside floated infobox

2026-05-20T14:03:51Z

Move at-a-glance listicle into lead (part 1/2): add above educational disclaimer to fill column beside floated infobox

← Older revision		Revision as of 14:03, 20 May 2026
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	Mesothelioma recurrence after pleurectomy/decortication (P/D) is virtually universal in long-term follow-up.<ref name="paajanen_2026" /> The largest dedicated analysis to characterize the pattern — the 2026 Brigham and Women's Hospital cohort by Juuso Paajanen and colleagues, published in ''Annals of Surgery'' (PubMed identifier (PMID) 39813065) — examined 436 patients with verified tumor recurrence from a population of 551 evaluable patients who underwent P/D with macroscopic complete resection (MCR) between 1998 and 2022. The dominant finding is that local recurrence occurred in 85% of patients (N=370) and was the sole site of first recurrence in 29% (N=129), making P/D-associated relapse predominantly a locoregional rather than distant event.<ref name="paajanen_2026" /> This page synthesizes the Paajanen anchor study, comparative recurrence geography after extrapleural pneumonectomy (EPP), the histologic and molecular predictors that shape post-operative trajectory (including BAP1, CDKN2A homozygous deletion, and tumor mutational burden), the role of intraoperative heated chemotherapy (IOHC), and the salvage options — including re-resection (Paajanen hazard ratio (HR) 0.46), hemithoracic intensity-modulated radiation therapy (IMRT), and second-line systemic therapy informed by CheckMate 743, MAPS, RAMES, and ATOMIC-Meso.<ref name="paajanen_2026" /><ref name="bellini_relapse" /><ref name="baas_checkmate743" /><ref name="zalcman_maps" /><ref name="szlosarek_atomic" />		Mesothelioma recurrence after pleurectomy/decortication (P/D) is virtually universal in long-term follow-up.<ref name="paajanen_2026" /> The largest dedicated analysis to characterize the pattern — the 2026 Brigham and Women's Hospital cohort by Juuso Paajanen and colleagues, published in ''Annals of Surgery'' (PubMed identifier (PMID) 39813065) — examined 436 patients with verified tumor recurrence from a population of 551 evaluable patients who underwent P/D with macroscopic complete resection (MCR) between 1998 and 2022. The dominant finding is that local recurrence occurred in 85% of patients (N=370) and was the sole site of first recurrence in 29% (N=129), making P/D-associated relapse predominantly a locoregional rather than distant event.<ref name="paajanen_2026" /> This page synthesizes the Paajanen anchor study, comparative recurrence geography after extrapleural pneumonectomy (EPP), the histologic and molecular predictors that shape post-operative trajectory (including BAP1, CDKN2A homozygous deletion, and tumor mutational burden), the role of intraoperative heated chemotherapy (IOHC), and the salvage options — including re-resection (Paajanen hazard ratio (HR) 0.46), hemithoracic intensity-modulated radiation therapy (IMRT), and second-line systemic therapy informed by CheckMate 743, MAPS, RAMES, and ATOMIC-Meso.<ref name="paajanen_2026" /><ref name="bellini_relapse" /><ref name="baas_checkmate743" /><ref name="zalcman_maps" /><ref name="szlosarek_atomic" />

			'''Recurrence and post-P/D recurrence at a glance:'''
			* '''Recurrence is virtually universal''' — 436 of 551 evaluable (79%) P/D patients in the Paajanen Brigham cohort developed verified recurrence during a median follow-up of 88.5 months.<ref name="paajanen_2026" />
			* '''85% local pattern''' — local recurrence occurred in 85% of recurrent cases (N=370) and was the sole site of first recurrence in 29% (N=129); residual thoracic cavity (72%), ipsilateral chest wall (55%), and diaphragm (22%) were the leading anatomical sites.<ref name="paajanen_2026" />
			* '''Histology dominates trajectory''' — sarcomatoid tumors relapsed earlier and more distantly (P=0.003 for time-to-recurrence; P<0.001 for distant spread); epithelioid tumors relapsed later and predominantly locally.<ref name="paajanen_2026" />
			* '''Intraoperative heated chemotherapy (IOHC, also known as Hyperthermic Intrathoracic Chemotherapy (HITHOC)) extends survival''' — IOHC was independently associated with longer disease-free interval (DFI; HR 0.60, P<0.001) and longer post-recurrence survival (PRS; HR 0.56, P<0.001).<ref name="paajanen_2026" /><ref name="ambrogi_hithoc" />
			* '''Salvage re-resection is independently survival-prolonging''' — among patients with distant or distant+local recurrences, recurrence surgery showed HR 0.46 (95% CI 0.29–0.74, P=0.0013) for PRS.<ref name="paajanen_2026" />
			* '''9.8-month median DFI; 12.7-month median PRS''' — in the recurrent cohort overall; 1-year recurrence-free survival 39%, 3-year 9%.<ref name="paajanen_2026" />
			* '''P/D ≠ EPP geography''' — contralateral chest recurrence is roughly half as common after P/D (18%) than after EPP (38%) from the Brigham comparison cohort; abdominal recurrence is 24% after P/D vs. 54% after EPP.<ref name="paajanen_2026" />
			* '''Modified Response Evaluation Criteria in Solid Tumours (mRECIST)''' — the Byrne and Nowak modified RECIST criteria are the standard for measuring tumor change in post-treatment surveillance imaging.<ref name="byrne_mrecist" />
			* '''Soluble Mesothelin-Related Peptides (SMRP / MESOMARK)''' — the only U.S. Food and Drug Administration (FDA)-cleared blood biomarker for monitoring biphasic and epithelioid mesothelioma; sensitivity is limited in sarcomatoid disease.<ref name="smrp_pilot_pmc" />
			* '''Circulating tumor DNA (ctDNA)''' — Johns Hopkins phase 2 perioperative immune checkpoint blockade trial (PMID 40921804) showed that undetectable ctDNA after neoadjuvant immunotherapy correlated with significantly longer event-free and overall survival, establishing molecular residual disease monitoring as feasible.<ref name="ctdna_jhu_natmed" />

	<div style="clear:both; background:#fff3cd; border:1px solid #ffc107; padding:12px; margin:1em 0; border-radius:6px;">		<div style="clear:both; background:#fff3cd; border:1px solid #ffc107; padding:12px; margin:1em 0; border-radius:6px;">

MesotheliomaSupport: Fix disclaimer div overflow: add clear:both so box clears infobox float

2026-05-20T13:46:23Z

Fix disclaimer div overflow: add clear:both so box clears infobox float

← Older revision		Revision as of 13:46, 20 May 2026
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	Mesothelioma recurrence after pleurectomy/decortication (P/D) is virtually universal in long-term follow-up.<ref name="paajanen_2026" /> The largest dedicated analysis to characterize the pattern — the 2026 Brigham and Women's Hospital cohort by Juuso Paajanen and colleagues, published in ''Annals of Surgery'' (PubMed identifier (PMID) 39813065) — examined 436 patients with verified tumor recurrence from a population of 551 evaluable patients who underwent P/D with macroscopic complete resection (MCR) between 1998 and 2022. The dominant finding is that local recurrence occurred in 85% of patients (N=370) and was the sole site of first recurrence in 29% (N=129), making P/D-associated relapse predominantly a locoregional rather than distant event.<ref name="paajanen_2026" /> This page synthesizes the Paajanen anchor study, comparative recurrence geography after extrapleural pneumonectomy (EPP), the histologic and molecular predictors that shape post-operative trajectory (including BAP1, CDKN2A homozygous deletion, and tumor mutational burden), the role of intraoperative heated chemotherapy (IOHC), and the salvage options — including re-resection (Paajanen hazard ratio (HR) 0.46), hemithoracic intensity-modulated radiation therapy (IMRT), and second-line systemic therapy informed by CheckMate 743, MAPS, RAMES, and ATOMIC-Meso.<ref name="paajanen_2026" /><ref name="bellini_relapse" /><ref name="baas_checkmate743" /><ref name="zalcman_maps" /><ref name="szlosarek_atomic" />		Mesothelioma recurrence after pleurectomy/decortication (P/D) is virtually universal in long-term follow-up.<ref name="paajanen_2026" /> The largest dedicated analysis to characterize the pattern — the 2026 Brigham and Women's Hospital cohort by Juuso Paajanen and colleagues, published in ''Annals of Surgery'' (PubMed identifier (PMID) 39813065) — examined 436 patients with verified tumor recurrence from a population of 551 evaluable patients who underwent P/D with macroscopic complete resection (MCR) between 1998 and 2022. The dominant finding is that local recurrence occurred in 85% of patients (N=370) and was the sole site of first recurrence in 29% (N=129), making P/D-associated relapse predominantly a locoregional rather than distant event.<ref name="paajanen_2026" /> This page synthesizes the Paajanen anchor study, comparative recurrence geography after extrapleural pneumonectomy (EPP), the histologic and molecular predictors that shape post-operative trajectory (including BAP1, CDKN2A homozygous deletion, and tumor mutational burden), the role of intraoperative heated chemotherapy (IOHC), and the salvage options — including re-resection (Paajanen hazard ratio (HR) 0.46), hemithoracic intensity-modulated radiation therapy (IMRT), and second-line systemic therapy informed by CheckMate 743, MAPS, RAMES, and ATOMIC-Meso.<ref name="paajanen_2026" /><ref name="bellini_relapse" /><ref name="baas_checkmate743" /><ref name="zalcman_maps" /><ref name="szlosarek_atomic" />

	<div style="background:#fff3cd; border:1px solid #ffc107; padding:12px; margin:1em 0; border-radius:6px;">		<div style="clear:both; background:#fff3cd; border:1px solid #ffc107; padding:12px; margin:1em 0; border-radius:6px;">
	'''Educational disclaimer:''' This page is for medical education and is not a substitute for individualized advice from a treating oncologist, thoracic surgeon, or palliative care team. Treatment decisions after P/D recurrence require multidisciplinary evaluation at a specialized mesothelioma program.		'''Educational disclaimer:''' This page is for medical education and is not a substitute for individualized advice from a treating oncologist, thoracic surgeon, or palliative care team. Treatment decisions after P/D recurrence require multidisciplinary evaluation at a specialized mesothelioma program.
	</div>		</div>

MesotheliomaSupport: Create wiki reference page: Paajanen 2026 Annals of Surgery anchor study (PMID 39813065, PMC13056416) — P/D-specific recurrence patterns, BAP1 predictors, salvage options. N=436 verified recurrence cases from Brigham IMP cohort. Research dossier 2026-05-19; CLEO PASS #7795; HAND triage #7736.

2026-05-19T19:51:00Z

Create wiki reference page: Paajanen 2026 Annals of Surgery anchor study (PMID 39813065, PMC13056416) — P/D-specific recurrence patterns, BAP1 predictors, salvage options. N=436 verified recurrence cases from Brigham IMP cohort. Research dossier 2026-05-19; CLEO PASS #7795; HAND triage #7736.

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