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. 2016 Sep;128(17-18):618-26.
doi: 10.1007/s00508-016-1036-3. Epub 2016 Jul 25.

Management of malignant pleural mesothelioma-part 2: therapeutic approaches : Consensus of the Austrian Mesothelioma Interest Group (AMIG)

Mir Alireza Hoda  1 , Thomas Klikovits  2 , Madeleine Arns  3 , Karin Dieckmann  4 , Sabine Zöchbauer-Müller  5 , Christian Geltner  6 , Bernhard Baumgartner  7 , Peter Errhalt  8 , Barbara Machan  9 , Wolfgang Pohl  10 , Jörg Hutter  11 , Josef Eckmayr  12 , Michael Studnicka  13 , Martin Flicker  14 , Peter Cerkl  15 , Walter Klepetko  2
Affiliations

Management of malignant pleural mesothelioma-part 2: therapeutic approaches : Consensus of the Austrian Mesothelioma Interest Group (AMIG)

Mir Alireza Hoda et al. Wien Klin Wochenschr. 2016 Sep.

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.

Keywords: Chemotherapy; Multimodality treatment; Palliative treatment; Radiotherapy; Surgery.

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Conflict of interest statement

Conflict of interestM.A. Hoda, T. Klikovits, M. Arns, K. Dieckmann, S. Zöchbauer-Müller, C. Geltner, B. Baumgartner, P. Errhalt, B. Machan, W. Pohl, J. Hutter, J. Eckmayr, M. Studnicka, M. Flicker, P. Cerkl, W. Klepetko, on behalf of the Austrian Mesothelioma Interest Group (AMIG) declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Postoperative situs after extrapleural pneumonectomy of the right lung and pleura. Intensity-modulated radiotherapy dose plan. Coronal, sagittal, and axial image of the isodose plan. Steep dose fall to the remaining left lung, liver, and kidney
Fig. 2
Fig. 2
Surgical setting and intraoperative pictures of extrapleural pneumonectomy (EPP): a positioning of patient in OR; b situs after extrapleural mobilization of the lung; c lung, diaphragm, and pericardium have been removed; d situs after reconstruction of diaphragm and pericardium
Fig. 3
Fig. 3
Proposed therapeutic algorithm in malignant pleural mesothelioma. MCR macroscopic complete resection, CHT chemotherapy, RT radiotherapy, DS downstaging, BSC best supportive care
See this image and copyright information in PMC

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