[Surgery for malignant pleural mesothelioma]

Malignant pleural mesothelioma (MPM) is an aggressive cancer of the pleura that is usually caused by exposure to asbestos. The incidence of MPM has risen for some decades and is expected to peak between 2010 and 2020. Current surgical treatment involves in a multimodality regimen with radiation and multiple-drug chemotherapy. All currently proposed therapeutic strategies are in total agreement with the international Mesothelioma Interest Group TNM staging system. Schematically: for stage Ia (early stage disease), the therapeutic approach is generally neo-adjuvant intrapleural treatment using cytikines followed by surgical pleurectomy; for more advanced disease (stage Ib, II and III), a multimodal treatment combining extra-pleural pneumonectomy, radiotherapy and multiple-drug chemotherapy, including in all cases cisplatin, is proposed. Recently, results using this multiple modality approach have been favorable especially for patients with epithelial histology, negative resection margins and no metastases to extrapleural lymph nodes; for stage IV (unresectable tumor), palliative treatment is indicated. Early results have been encouraging and the use of recent drugs should allow more optimal treatment.