Advances in the treatment of malignant pleural mesothelioma

Malignant pleural mesothelioma is a neoplasm that is commonly fatal and for which there are no widely accepted curative approaches. Mesothelioma is un responsive to most chemotherapy and radiotherapy regimens, and it typically recurs even after the most aggressive attempts at surgical resection. Mult imodality approaches have been of some benefit in prolonging survival of ve ry highly selected subgroups of patients, but they have had a relatively sm all impact on the majority of the patients diagnosed with this disease. As the incidence of pleural mesothelioma peaks in the United States and Europe over the next 10 to 20 years, new therapeutic measures will be necessary. This review will discuss the roles of chemotherapy, radiotherapy, surgery, and combined modality approaches in the treatment of pleural mesothelioma, as well as scientific advances made in the past decade that have led to the development of experimental techniques, such as photodynamic therapy, immu notherapy, and gene therapy that are currently undergoing human clinical tr ials, These promising new avenues may modify the therapeutic nihilism that is rampant among clinicians dealing with mesothelioma.