MALIGNANT PLEURAL MESOTHELIOMA

The incidence of malignant pleural mesothelioma (MPM) has risen for so me decades and is expected to peak between 2010 and 2020, Up to now no single treatment has been proven to be effective and death usually oc curs within about 12- 17 months after diagnosis. Perhaps because of th is poor prognosis, early screening has incited little interest However , certain forms may have a better prognosis when diagnosed early and t reated by multimodal therapy or intrapleural immunotherapy, Diagnosis depends foremost on histological analysis of samples obtained by thora coscopy This procedure allows the best staging of the pleural cavity w ith an attempt to detect visceral pleural involvement, which is one of the most important prognostic France factors, Although radiotherapy s eems necessary and is efficient in preventing the malignant seeding af ter diagnostic procedures in patients,there has been no randomized pha se III study showing the superiority of any treatment compared with an other. However, for the early-stage disease (stage I) a logical therap eutic approach seems to be neoadjuvant intrapleural treatment using cy tokines, For more advanced disease (stages II and III) resectability s hould be discussed with the thoracic surgeons and a multimodal treatme nt combining surgery, radiotherapy and chemotherapy should be proposed for a randomized controlled study. Palliative treatment is indicated for stage IV, In any case, each patient should be enrolled in a clinic al trial. (C) ERS Journals Ltd 1998.