Treatment of malignant mesothelioma

Malignant pleural mesothelioma (MPM) is a rare tumor that predominantly aff licts men over 50 years of age. Nearly 3000 MPMs are reported annually in t he United States with the incidence expected to rise into the new millenium . Over the past 40 years, MPM has been unequivocally linked to asbestos exp osure worldwide. Recently, however, a new theory on the carcinogenesis of t his tumor has been proposed with the isolation of a simian virus (SV 40) li ke gene sequence in mesothelioma tumor cells. The clinical presentation of MPM is variable, although most patients typically present with dyspnea, che st pain, or pleural effusion. Obtaining a diagnosis of MPM has been greatly assisted by video-assisted surgery and the use of immunohistochemistry and electron microscopic techniques, which help distinguish MPM from other tum or pathologies such as adenocarcinoma. Computed tomography and magnetic res onance imaging have been also useful for determining tumor burden and resec tability. Traditionally, strategies for the treatment of MPM have included supportive care, surgery, radiotherapy, and chemotherapy. Survival with sup portive care alone ranges between 4 and 12 months. Single-modality therapy using traditional approaches (surgery, radiotherapy, chemotherapy) alone ha s failed to improve patient survival significantly. Recently, results using a multimodality approach have been favorable. In particular, cytoreductive surgery (pleuropneumonectomy) followed by sequential chemotherapy and radi otherapy have demonstrated improved survival, especially for patients,vith epithelial histology, negative resection margins, and no metastases to extr apleural lymph nodes. Innovative therapies such as the use of photodynamic, targeted cytokines and gene therapy are currently being investigated for m anagement of MPM.