[Current status of surgical treatment for malignant pleural mesothelioma]

Malignant pleural mesothelioma (MPM) is a rare thoracic malignancy associated with very poor prognosis. Extrapleural pneumonectomy (EPP), a very invasive surgery where en bloc resection of ipsilateral pleura, lung, and a part of diaphragm and pericardium is required, is performed with curative intent However, EPP remains to be cytoreductive rather than radical surgery for MPM, because its goal is macroscopic complete resection. In this context, preoperative chemotherapy with cisplatin and pemetrexed, followed by EPP and postoperative hemithoracic radiation is currently considered as "standard therapy" for resectable MPM. Results of recent major clinical trials on trimodality treatment (TMT) for MPM were not encouraging; TMT was completed in approximately 50% of enrolled patients, and overall survival ranged 14 to 18.4 months. However, in Toronto trial, median survival reached to 59 months in patients who had no mediastinal node involvement and completed the entire TMT. This fact clearly illustrates that patient selection plays a key roll in MPM treatment. An all-Japan clinical study on TMT feasibility is currently underway.