[Therapy of malignant pleural mesothelioma--a permanent dilemma]

Although still a rare tumour, incidence of malignant pleural mesothelioma (MPM) is increasing. The cause, with the exception of some not clearly identified environmental factors, is asbestos. The prognosis is influenced by the stage of the disease. A new staging system has not modified the fact that staging is still a clinical problem. Tumour volume, histological subtype, sex and performance score are some of the important prognostic factors. Most patients (pts) are diagnosed in advanced stages only. Surgery will only cure or significantly prolong survival in the rare event of an early stage with no survival advantage for pleuropneumonectomy over pleurectomy. In early stages adjuvant immunological treatments (e.g. interferon or interleukin) may be of some value. Adjuvant first generation photodynamic therapy is not superior to operation only. The majority of patients, however, are diagnosed in advanced stages, where neither radiation nor chemotherapy, nor multimodality treatments can significantly alter the poor prognosis. There is no standard therapy, and no advantage to poly- versus monochemotherapy. Chemotherapy, however, seems to have some palliative effect in symptomatic patients, as well as radiotherapy, the latter also as prophylaxis against tumour invasion after puncture and thoracoscopy.