Malignant pleural mesothelioma.
Malignant pleural mesothelioma remains a difficult tumor to treat, much less cure. Currently, the best chance for long-term survival lies with early diagnosis and aggressive surgical extirpation, but given the typically long delay between the onset of symptoms and diagnosis, this is only possible with a high index of suspicion and an aggressive diagnosis workup. Early referral to a tertiary center experienced in the treatment of MPM may be important for several reasons: (1) decreased risk of tumor spread along multiple thoracenesis/biopsy tracts, (2) the availability of specialized pathologic assays for definitive diagnosis, (3) the availability of critical staging modalities (aggressive mediastinoscopy +/- thoracoscopy, MRI scans performed according to specific mesothelioma protocols, and perhaps PET scans), (4) surgical experience with pleurectomy/decortication and/or extrapleural pneumonectomy, that may decrease morbidity and mortality, and (5) the availability of novel adjuvant protocols. Single-modality therapy is unlikely to result in long-term survival. Aggressive surgery is required for optimal debulking, and extrapleural pneumonectomy may offer better local control compared with pleurectomy/ecortication. Delivery of optimal radiation schedules, which may involve large fractions as well as large total doses, is limited by the presence of nearby dose-limiting structures. Current chemotherapy is severely lacking in producing objective responses and improved survival although gemcitabine and IL-2 may be active agents to be combined with radiation and/or other agents. Hyperthermia, photodynamic therapy, intracavitary therapy, and gene therapy are all relatively new techniques under active investigation that should be supported by enrollment in on-going protocols. Predictably, many of these techniques provide greater benefit when used in the setting of adjuvant protocols or minimal residual disease, emphasizing the importance of multimodality therapy.
M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Skarin
D000328:Adult; D000368:Aged; D000818:Animals; D016588:Anticarcinogenic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001194:Asbestos / Q000009:adverse effects; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D006224:Cricetinae; D016207:Cytokines / Q000627:therapeutic use; D003952:Diagnostic Imaging; D018450:Disease Progression; D004340:Drug Contamination; D005260:Female; D015316:Genetic Therapy; D006801:Humans; D006979:Hyperthermia, Induced; D007372:Interferons / Q000627:therapeutic use; D015993:Life Tables; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000517:prevention & control / Q000628:therapy / Q000821:virology; D051379:Mice; D008819:Mice, Nude; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009367:Neoplasm Staging / Q000379:methods; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology / Q000209:etiology; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology; D010166:Palliative Care; D010778:Photochemotherapy; D016066:Pleural Effusion, Malignant / Q000209:etiology; D010997:Pleural Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000517:prevention & control / Q000628:therapy / Q000821:virology; D011054:Poliovirus Vaccine, Inactivated; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013539:Simian virus 40 / Q000472:pathogenicity; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D023041:Xenograft Model Antitumor Assays
D016588:Anticarcinogenic Agents; D016207:Cytokines; D011054:Poliovirus Vaccine, Inactivated; D001194:Asbestos; D007372:Interferons