title: Multimodal therapy of malignant pleural mesothelioma: is the replacement of radical surgery imminent?
abstract: OBJECTIVE
  Malignant pleural mesothelioma (MPM) remains an aggressive thoracic malignancy associated with poor prognosis. There is no standard treatment regimen, and particularly, the impact of radical surgery remains controversial. The main goal of our retrospective single-centre study was to evaluate the surgical and non-surgical treatment modalities applied at our division regarding their effect on the patient's survival.
  
  
  METHODS
  During the last decade, 82 patients with histologically confirmed MPM were treated at our division. The complete clinical records of 61 patients were eligible for statistical evaluation.
  
  
  RESULTS
  There were 14 women (23%) and 47 men (77%) with a mean age of 63.7 years. Epitheloid subtype was found in 48 patients (78.7%), sarcomatoid in 3 (4.9%) and biphasic in 10 (16%). Surgery as the first treatment modality was performed in 44 patients (72.1%). Pleurectomy/decortication was done in 28 cases (45.9%), extended pleurectomy/decortication was performed in 13 (21.3%) and extrapleural pneumonectomy in 3 (4.9%). Additional intraoperative photodynamic therapy was administered in 20 patients, 34 underwent chemotherapy (55.7%) and 12 had radiotherapy (19.7%). Mean survival time for the collective was 18.3 months. Five-year survival was 17% in the epitheloid histology group, where patients treated with chemotherapy alone yielded a significant increase in survival (P = 0.049), and those with other subtypes survived for a maximum of 20.6 months.
  
  
  CONCLUSIONS
  Chemotherapy and pleurectomy/decortication can extend the survival time of patients with MPM remarkably. The adequate treatment options have to be tailored to the specific particular needs of each patient considering histological subtype, tumour stage and patient's individual functional assessment as well as comorbidity.
authors.affiliation: Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Austria. jo.lindenmann@medunigraz.at
authors.forename: Joerg
authors.initials: J
authors.lastname: Lindenmann
authors.forename: Veronika
authors.initials: V
authors.lastname: Matzi
authors.forename: Nicole
authors.initials: N
authors.lastname: Neuboeck
authors.forename: Udo
authors.initials: U
authors.lastname: Anegg
authors.forename: Alfred
authors.initials: A
authors.lastname: Maier
authors.forename: Josef
authors.initials: J
authors.lastname: Smolle
authors.forename: Freyja Maria
authors.initials: FM
authors.lastname: Smolle-Juettner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D018579:Patient Selection; D010778:Photochemotherapy; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D057216:Propensity Score; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome