DIFFUSE MALIGNANT PLEURAL MESOTHELIOMA IN DIAGNOSIS, THERAPY, AND PROGNOSIS - A REVIEW

The incidence of diffuse, malignant pleural mesothelioma is closely re lated to occupational asbestos exposure. Furthermore, this disease is the most frequently found occupational cancer. Due to the long latency period between exposure and tumor manifestation, diffuse malignant pl eural mesothelioma is most commonly found in patients with 50 to 70 ye ars of age. Currently due to the fact that no standard therapy exists, pragmatic individual treatment decisions are the rule and include sur gery, radiotherapy, chemotherapy or simply a symptomatic relief Surviv al chances are best when the tumor can be completely removed by surger y. Surgical options to be considered are the extrapleural pneumonectom y, pleurectomy or decortication, the partial pleurectomy and thoracoso copy with subsequent pleural drainage and durg instillation. Radiother apy is employed palliatively to relieve symptoms and prevent complicat ions. Unfortunately, the diffuse, malignant peural mesothelioma has pr oved to be exceptionally resistant to chemotherapy. No standard cytoto xic treatment has been developed. The most frequently used chemotherap y has included anthracycline and cisplatin, where the response rates r ange from 10 to 20%. Complete remissions are never achieved. Combinati on chemotherapy has not proven to have any advantage over single agent therapy. There is also no evidence that the use of chemotherapy withi n multimodality treatment protocols, including radiotherapy and/or sur gery, can improve results. New cytotoxic drugs, such as taxans or gemc itabine, are currently being clinically tested. The comparatively high response rates shown by high-dose methotrexate and edatraxate have ye t to be confirmed. The purpose of this report is to summarize the curr ent status of diffuse malignant pleural mesothelioma - its diagnosis, therapy, and prognosis.