[Mesothelioma of the pleura and peritoneum. Diagnostic and therapeutic sequelae]

In patients with pleural or peritoneal mesothelioma, surgery is a technically difficult procedure. Whereas those rare forms of localized pleural mesotheliomy are being detected incidentally and can be cured by complete resection, most patients with diffuse malignant mesothelioma present with an advanced stage of disease. Most of these patients survive less than 12 months irrespective of the treatment modality. For diffuse pleural mesothelioma, some favorable prognostic factors were identified: IMIG (International Mesothelioma Interest Group), stages I and II, epithelial type, age under 50, female gender. In IMIG stages I and II, extended pleuropneumonectomy followed by chemo- and/or radiotherapy is recommended. For this subset of patients, a median survival time of between 20 and 30 months is reported. Pleurectomy and decortication are recommended as palliative surgical strategies against pleural effusion. In patients with technically inoperable infiltration of the thoracic wall, irradiation is helpful; sometimes partial remission and relief of pain can be achieved by chemotherapy.