title: Multimodal management of malignant pleural mesothelioma: where are we today?
abstract: The prognosis of patients with malignant pleural mesothelioma remains poor and although it is clear that multimodal therapy is necessary to improve long-term results, precise treatment schemes have not yet been unequivocally established. Single-modality therapy does not have a major impact on long-term survival and combined-modality therapies are being further evaluated. However, the relative contributions of chemotherapy, radiotherapy and surgery have not been clearly determined at the present time. Moreover, the extent of resection and precise surgical procedure remain a highly debated topic. To better compare and combine results from different institutions and trials, uniform definitions of surgical procedures including extrapleural pneumonectomy and different forms of pleurectomy have recently been introduced. Due to the relatively higher morbidity and mortality of extrapleural pneumonectomy, there is currently a shift towards pleurectomy/decortication when a macroscopic complete resection of all tumour can be obtained by this procedure. In most recent trials, induction chemotherapy was administered to improve surgical resection rates but pathological complete responses are infrequently observed. The role of post-operative radiotherapy has to be further elucidated. Further treatment options that are currently explored include hyperthermic intrapleural chemotherapy, immunotherapy, gene therapy and photodynamic therapy. However, no randomised comparisons are available yet.
authors: Dept of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium paul.van.schil@uza.be.
authors: Paul E
authors: PE
authors: Van Schil
authors: Division of Thoracic Surgery, University Hospital, Zurich, Switzerland.
authors: Isabelle
authors: I
authors: Opitz
authors: Division of Thoracic Surgery, University Hospital, Zurich, Switzerland.
authors: Walter
authors: W
authors: Weder
authors: Dept of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium.
authors: Christophe
authors: C
authors: De Laet
authors: Dept of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium.
authors: Andreas
authors: A
authors: Domen
authors: Dept of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium.
authors: Patrick
authors: P
authors: Lauwers
authors: Dept of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium.
authors: Jeroen M
authors: JM
authors: Hendriks
authors: Multidisciplinary Oncological Centre Antwerp, Division of Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium.
authors: Jan P
authors: JP
authors: Van Meerbeeck
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011013:Pneumonectomy / Q000379:methods*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012107:Research Design; D019616:Thoracic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome