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.
Ho
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M.D. Anderson Cancer Center, Houston, TX 77030, USA.
Sugarbaker
D J
DJ
Skarin
A T
AT
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