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25-07-2016 | Mesothelioma | Article

Management of malignant pleural mesothelioma—part 2: therapeutic approaches

Journal:
Wiener klinische Wochenschrift

Authors: Ass. Prof. Dr. Mir Alireza Hoda, Thomas Klikovits, Madeleine Arns, Karin Dieckmann, Sabine Zöchbauer-Müller, Christian Geltner, Bernhard Baumgartner, Peter Errhalt, Barbara Machan, Wolfgang Pohl, Jörg Hutter, Josef Eckmayr, Michael Studnicka, Martin Flicker, Peter Cerkl, Walter Klepetko

Publisher: Springer Vienna

Abstract

Treatment of malignant pleural mesothelioma (MPM) depends on performance status of the patient, tumor stage, and histological differentiation. Chemotherapy (CHT) can be administered as first- and second-line treatment in unresectable MPM or as neoadjuvant or adjuvant treatment before or after surgery. A combination of an antifolate and platinum-based CHT is the only approved standard of care. Several targeted and immunotherapies are in evaluation and further studies are warranted to determine the therapeutic value of these new treatment options. Radiotherapy (RT) can be considered either as adjuvant treatment after surgery or for palliation of pain-related tumor growth. Recent data support the use of RT in a neoadjuvant setting. Macroscopic complete resection by pleurectomy/decortication (P/D) or extrapleural pneumonectomy (EPP) is indicated in selected patients with good performance status. Surgery should only be applied as part of a multimodality treatment (MMT) in combination with chemo- and/or radiotherapy. In a large number of cases, palliative attempts are needed to improve quality of life and to achieve symptom control.

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