Multimodality therapy for malignant pleural mesothelioma.

Abstract

To date, it is widely accepted that best long term results after treatment for malignant pleural mesothelioma are achieved when several modalities are combined. However, there is still a debate which combination of treatment in which stage of the disease and for which patient should be recommended and different institutions follow different treatment regimens. If mesothelioma is in a resectable stage, macroscopic complete resection (MCR) - realized as extrapleural pneumonectomy (EPP) or radical pleurectomy/decortication (P/D) - is the basic concept, to be supplemented by chemo- and/or radiotherapy either in a neo-adjuvant or adjuvant combination. Various local therapies during surgery are also applied. Combining EPP with adjuvant chemo-radiotherapy, median overall survival (OS) data are consistently reported to range between 13-23.9 months. Applying chemotherapy as an induction concept (neo-adjuvant chemotherapy) median overall survival is in a comparable range and reaches up to 29.1 months [reviewed in (1)]. We herein discuss the individual modalities of multimodality therapy - surgery, chemotherapy, radiotherapy, as well as other possible modules of a multimodal therapy.