Malignant Pleural Mesothelioma in 2011. Is there a Gold Standard Therapy?
Steven C. Bharadwaj,
Alexander S. Farivar.
Malignant pleural mesothelioma (MPM) is an aggressive malignancy. It most frequently develops following
occupational exposure to asbestos, a highly flame-retardant material used in construction. The delay between exposure
and development of MPM ranges from 25-50 years and therefore most patients present in the 5th to 7th decade of life.
MPM can present like many other common pleural diseases therefore diagnosis requires clinical acumen. Tissue sampling
is required with best results from directed pleural biopsy.
Once a diagnosis of MPM has been made, treatment depends upon the stage of disease, histological diagnosis and
performance status of the patient. Palliation is reserved for patients with multiple comorbidities that are unlikely to
withstand aggressive treatment or patients with advanced disease involving the peritoneum or contralateral hemithorax.
Those presenting with epithelial histology, earlier stage and good performance status are candidates for multimodality
therapy. Case series report long term survival in patients treated with a trimodality approach involving chemotherapy,
surgery and radiation. Our approach is to carefully select patients by thoroughly evaluating patient’s physiological status
and clinical stage of disease before embarking on induction chemotherapy, extrapleural pneumonectomy and
postoperative radiotherapy. By utilizing this paradigm we report outcomes similar to other expert groups treating this
aggressive malignancy. In order to improve upon outcomes, novel chemotherapeutic targets need to be identified.
Molecular biological techniques are uncovering potential mediators in the carcinogenesis of MPM.
Keywords: Asbestos, chemotherapy, extrapleural pneumonectomy, IMRT, Malignant pleural mesothelioma, palliation,
pleurectomy/decortication, trimodality therapy, pleural biopsy, peritoneum or contralateral hemithorax.
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