[Therapeutic strategies for resectable malignant pleural mesothelioma]

Malignant pleural mesothelioma (MPM) is a rare thoracic malignancy associated with very poor prognosis. Because no single treatment is very effective for MPM, a combination of preoperative chemotherapy, extrapleural pneumonectomy, and postoperative hemithoracic radiation is currently considered the "standard" therapy for resectable MPM. As such an aggressive protocol involves very high risk, maximum preoperative assessment for durability and curability is required. Very recently, the results of three major clinical trials of trimodality treatment for MPM have been reported from North America and Europe. The therapeutic regimens and results of these trials were similar. Although the overall results were not encouraging, surprisingly good survival rates were noted in patients who had no mediastinal node involvement and completed the entire trimodality therapy regimen. This clearly illustrates that patient selection plays a key role in MPM treatment. Two other important clinical trials are currently ongoing. The Mesothelioma and Radical Surgery (MARS) trial is a randomized clinical trial seeking to clarify the role of radical surgery in MPM treatment. An all-Japan clinical study of trimodality treatment for MPM is currently underway as a part of a national campaign entitled "Comprehensive Strategy against Asbestos-Related Diseases."