title: Improving the outcome in malignant pleural mesothelioma: nonaggressive or aggressive approach?
abstract: OBJECTIVE
  The treatment of malignant pleural mesothelioma continues to be a clinical challenge. The question, however, is no longer whether to provide active treatment or not, but how aggressive the treatment should be in view of the limited life expectancy of patients with this disease.
  
  
  RESULTS
  With platin and pemetrexed-based combination chemotherapy having become the preferred systemic therapy, the major questions now evolve around the identification of a suitable second line therapy and the quest for innovative new approaches. Surgical interventions from pleurectomy and decortication to extrapleural pneumonectomy have increasingly come of use in specialized centres. With neoadjuvant chemotherapy and extrapleural pneumonectomy median survival times of almost 2 years have been reported. Studies on high-dose hemithoracic radiotherapy after extrapleural pneumonectomy suggested a beneficial effect on local recurrence. However, both extrapleural pneumonectomy and high-dose hemithoracic radiotherapy are associated with potential treatment-related mortality and morbidity and cannot yet be recommended outside specialized centres.
  
  
  CONCLUSIONS
  More than ever, the diagnosis and treatment of patients with malignant pleural mesothelioma mandate a multidisciplinary approach.
authors.affiliation: Clinic and Policlinic of Oncology and Thoracic Surgery, University Hospital, Zürich CH 8091, Switzerland. rolf.stahel@usz.ch
authors.forename: Rolf A
authors.initials: RA
authors.lastname: Stahel
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
mesh_terms: D006801:Humans; D008654:Mesothelioma / Q000628:therapy*; D020360:Neoadjuvant Therapy; D010997:Pleural Neoplasms / Q000628:therapy*; D013510:Pulmonary Surgical Procedures; D015996:Survival Rate; D016896:Treatment Outcome