Multidisciplinary treatment of malignant pleural mesothelioma
Abstract
The incidence of malignant pleural mesothelioma (MPM) is increasing worldwide, and is predicted to peak in the next 10–20 years. Difficulties in MPM diagnosis and staging, especially of early disease, have thwarted the development of a universally accepted therapeutic approach. Single modality therapies (surgery, radiotherapy, chemotherapy) have generally failed to.......more on The Oncologist>>
Introduction
Malignant pleural mesothelioma (MPM) is an aggressive tumor, usually associated with a poor prognosis. The incidence of MPM is increasing throughout most of the world, and it is expected to rise in the next 10–20 years as a result of widespread exposure to asbestos in the past decades. The management of patients with MPM is controversial. Difficulties in diagnosing and staging, especially in early disease, have thwarted the development of a generally accepted stage-related approach. MPM is a heterogeneous disease often associated with different clinical courses; a number of prognostic factors have been described, and two major prognostic scoring systems have been.....more on The Oncologist>>
Staging
Correct clinical staging is mandatory in the approach to treat MPM. Early staging systems have reflected mainly the experiences of individual institutions on their respective patient populations; considerable discrepancies among the various systems have resulted in nonuniformity of reporting. At present, the recommended classification for clinical use is the International Mesothelioma Interest Group (IMIG) staging system, which is based mainly on surgical and pathological variables, and may not be completely applicable to cross-sectional imaging; moreover, the lymphatic drainage of the pleura is quite complex and is not fully reflected in the IMIG system, in which....more on The Oncologist>>
Chemotherapy
Most patients with MPM are potential candidates for chemotherapy at some point in their treatment. For many years a nihilistic attitude has existed about medical treatment of MPM. Most chemotherapy studies have used either single agents or combination regimens in the setting of small phase II trials; the rates of objective tumor regression have been generally <20%, with no significant impact on median survival. In a meta-analysis of early trials published between 1965 and 2001, cisplatin was found to be the most active single drug. Combination chemotherapy has been associated with higher response rates, but not with....more on The Oncologist>>
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