title: Management of malignant pleural mesothelioma-part 2: therapeutic approaches : Consensus of the Austrian Mesothelioma Interest Group (AMIG).
abstract: Treatment of malignant pleural mesothelioma (MPM) depends on performance status of the patient, tumor stage, and histological differentiation. Chemotherapy (CHT) can be administered as first- and second-line treatment in unresectable MPM or as neoadjuvant or adjuvant treatment before or after surgery. A combination of an antifolate and platinum-based CHT is the only approved standard of care. Several targeted and immunotherapies are in evaluation and further studies are warranted to determine the therapeutic value of these new treatment options. Radiotherapy (RT) can be considered either as adjuvant treatment after surgery or for palliation of pain-related tumor growth. Recent data support the use of RT in a neoadjuvant setting. Macroscopic complete resection by pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP) is indicated in selected patients with good performance status. Surgery should only be applied as part of a multimodality treatment (MMT) in combination with chemo- and/or radiotherapy. In a large number of cases, palliative attempts are needed to improve quality of life and to achieve symptom control.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. mir.hoda@meduniwien.ac.at.
authors.forename: Mir Alireza
authors.identifier: http://orcid.org/0000-0002-7088-8768
authors.initials: MA
authors.lastname: Hoda
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Klikovits
authors.affiliation: Department of Pulmonology, Landesklinikum Hochegg, Hochegg, Austria.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Arns
authors.affiliation: Department of Radiation Oncology, Medical University Vienna, Vienna, Austria.
authors.forename: Karin
authors.initials: K
authors.lastname: Dieckmann
authors.affiliation: Department of Oncology, Medical University Vienna, Vienna, Austria.
authors.forename: Sabine
authors.initials: S
authors.lastname: Zöchbauer-Müller
authors.affiliation: Department of Pulmonology, Klinikum Klagenfurt, Klagenfurt, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Geltner
authors.affiliation: Department of Pulmonology, Landeskrankenhaus Vöklabruck, Vöklabruck, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Baumgartner
authors.affiliation: Department of Pulmonology, University Clinic Krems, Krems, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Errhalt
authors.affiliation: Rehabilitation Center Tobelbad, Allgemeine Unfallversicherungsanstalt, Tobelbad, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: Machan
authors.affiliation: Department of Pulmonology, KH Hietzing, Karl Landsteiner Institute for Clinical and Experimental Pneumology, Vienna, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Pohl
authors.affiliation: Department of Surgery, University Clinic Salzburg, Salzburg, Austria.
authors.forename: Jörg
authors.initials: J
authors.lastname: Hutter
authors.affiliation: Department of Pulmonology, Landeskrankenhaus Wels, Wels, Austria.
authors.forename: Josef
authors.initials: J
authors.lastname: Eckmayr
authors.affiliation: Department of Pulmonology, University Clinic Salzburg, Salzburg, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Studnicka
authors.affiliation: Department of Pulmonology, Landeskrankenhaus Leoben, Leoben, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Flicker
authors.affiliation: Department of Pulmonology, Landeskrankenhaus Hohenems, Hohenems, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Cerkl
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
authors.forename: Walter
authors.initials: W
authors.lastname: Klepetko
mesh_terms: D001317:Austria; D059248:Chemoradiotherapy / Q000592:standards*; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine / Q000592:standards; D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D008654:Mesothelioma / Q000175:diagnosis / Q000628:therapy*; D016066:Pleural Effusion, Malignant / Q000628:therapy*; D010997:Pleural Neoplasms / Q000628:therapy*; D017410:Practice Guidelines as Topic; D019616:Thoracic Surgical Procedures / Q000592:standards*; D016896:Treatment Outcome
keywords: Chemotherapy; Multimodality treatment; Palliative treatment; Radiotherapy; Surgery