[Malignant pleural mesothelioma]

Abstract

Malignant pleural mesothelioma is a severe disease closely associated with asbestos exposure, at work or environmental. Its incidence has risen for some decades and it's expected to peak between 2010 and 2020. Up today, no treatment has been demonstrated as effective in influencing disease-related survival and the median prognosis ranges between 9 and 17 months after the diagnosis. The epithelial subtype of the disease seems to have a better prognosis when early diagnosed and treated with intrapleural immunotherapy or multimodality therapy. The diagnosis of the disease, often by exclusion, is obtained after macroscopic sampling of the pathological tissue, best accomplished by thoracoscopy, which also allows the intracavitary evaluation of the extension of the disease. Chemotherapy and radiotherapy alone didn't demonstrate any efficacy on the patient survival. For the early-stage disease (stage I) a therapeutic approach seems to be neoadjuvant intrapleural treatment using cytokines. For more advanced disease (stages II and III) resectability should be discussed with the thoracic surgeons and a multimodality treatment combining surgery, radiotherapy and chemotherapy should be proposed. This multimodality protocol has proved to be effective in patients with epithelial subtype, negative margins of resection and negative lymph nodes.