MALIGNANT PLEURAL MESOTHELIOMA

The rate of diagnosis’ of malignant pleural mesothelioma has risen for some decades and is expected to peak between 2010 and 2020. That could mean more than 6000 people a year die from mesothelioma. Up to now, no single treatment has been proven to be effective and death usually occurs within about 6-18 months after diagnosis. Perhaps because of this poor prognosis, early screening has incited little interest.

However, certain forms may have a better prognosis when diagnosed early and treated by multimodal therapy or intrapleural immunotherapy. Diagnosis depends foremost on histological analysis of samples obtained by thoracoscopy. This procedure allows the best staging of the pleural cavity with an attempt to detect visceral pleural involvement, which is one of the most important prognostic factors. In saying this please note that early detection is key but often times malignant pleural mesothelioma is mistaken for pneumonia. If you have been exposed to asbestos you must have your physician perform a thorough exam and include all forms of X-ray and Ct type testing available to you., Although radiotherapy seems necessary and is efficient in preventing the malignant seeding after diagnostic procedures in patients, there has been no randomized phase III study showing the superiority of any treatment compared with another. However, for the early-stage disease (stage I) a logical therapeutic approach seems to be neoadjuvant intrapleural treatment using cytokines.

For more advanced malignant pleural mesothelioma resectability should be discussed with the thoracic surgeons and a multimodal treatment combining surgery, radiotherapy and chemotherapy should be proposed for a randomized controlled study. Palliative treatment is indicated for stage IV and is more for comfort to the patient than anything else at this point. In any case, each patient should be enrolled in a clinical trial at the onset of diagnosis of malignant pleural mesothelioma.

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