[Malignant pleural mesothelioma]

The malignant pleural mesothelioma is a rare tumor of the general population. The exposure of asbestos still remains the main factor of risk, found in 72 to 95 % of the patients. The diagnosis is difficult. The symptoms are poor, with most often chronic pleural effusion, with dyspnea, associated with localized chest pain. The histological diagnosis is made on thoracoscopic biopsy. Analysis of the histochemical profile (PAS-D, hyaluronidase, vimentine), the use of immunochemistry (CEA, keratines), and electron microscopy can facilitate the making of the diagnosis. There is 3 different entities of malignant mesothelioma: the epithelial type, mixed, and sarcomatous. The tagging is based on thoracic scanner, to determinate the extent of the tumor, her relation with the local structures, and the possible involvement of the mediastinal lymph nodes. There is several staging systems, the Butchart's staging classification, and most recently the IMIG (International Mesothelioma Interest Group) classification. The significant prognostic factors, in multivariate analysis are: the stage of the disease, the histologic type, and the performance status of the patient. The current therapeutic maneuvers (surgery, chemotherapy, radiotherapy) did not show significant improvement of the survival. The radical surgery, like pleuropneumonectomy, should be consider only for patients with an early stage of the disease. The chemotherapy, with single agent or in combination, still remains disappointing, with objective response rates between 20 and 30 %, in best cases. The curative radiotherapy is limited by the importance of the target-volume, and the proximity of critical organ (lung, heart). Only the preventive radiotherapy, on scars, niddle or surgical tracts is recommended. Immunotherapy, by systemic or intracavitary administration, remains limited because of the toxicity, especially infection. All of the therapeutic maneuvers should be proposed in clinical trials.