Surgery for malignant pleural mesothelioma: Why, when and what?

TY - JOUR

T1 - Surgery for malignant pleural mesothelioma

T2 - Why, when and what?

AU - Lang-Lazdunski, Loic y

PY - 2014/5

Y1 - 2014/5

N2 - Malignant pleural mesothelioma is a fatal cancer developing in the pleural cavity, linked to asbestos exposure. Various therapies have been tried in the past 50 years including surgery, radiotherapy, chemotherapy, immunotherapy and more recently, targeted therapy. Radical surgery remains controversial in malignant pleural mesothelioma and two procedures have been offered in the past to obtain maximal cytoreduction: extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). Despite growing evidence that EPP might be detrimental, many believe that radical surgery should still be part of multimodality therapy in patients with malignant pleural mesothelioma. Recent evidence suggests that P/D is well tolerated and produces low mortality and morbidity. The role of adjuvant intrapleural therapies remains to be determined and evaluated in large prospective trials. Pleurectomy/decortication does not jeopardize the chance of having chemotherapy, or chemoradiotherapy either. Many now believe that it should be the default procedure in multimodality regimens. However, this remains to be proven in a large randomized trial. Palliative surgery still has an important role to play in mesothelioma, in establishing or refining diagnosis and in controlling symptoms and improving quality of life in many patients whose life expectancy is limited. Recent progress in molecular analyses and biomarkers should help with patient selection for surgery, immunotherapy and systemic therapies in the near future.

AB - Malignant pleural mesothelioma is a fatal cancer developing in the pleural cavity, linked to asbestos exposure. Various therapies have been tried in the past 50 years including surgery, radiotherapy, chemotherapy, immunotherapy and more recently, targeted therapy. Radical surgery remains controversial in malignant pleural mesothelioma and two procedures have been offered in the past to obtain maximal cytoreduction: extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). Despite growing evidence that EPP might be detrimental, many believe that radical surgery should still be part of multimodality therapy in patients with malignant pleural mesothelioma. Recent evidence suggests that P/D is well tolerated and produces low mortality and morbidity. The role of adjuvant intrapleural therapies remains to be determined and evaluated in large prospective trials. Pleurectomy/decortication does not jeopardize the chance of having chemotherapy, or chemoradiotherapy either. Many now believe that it should be the default procedure in multimodality regimens. However, this remains to be proven in a large randomized trial. Palliative surgery still has an important role to play in mesothelioma, in establishing or refining diagnosis and in controlling symptoms and improving quality of life in many patients whose life expectancy is limited. Recent progress in molecular analyses and biomarkers should help with patient selection for surgery, immunotherapy and systemic therapies in the near future.

KW - Malignant pleural mesothelioma

KW - Radical surgery

KW - Extrapleural pneumonectomy

KW - Pleurectomy

KW - VATS

KW - SPARING RADICAL PLEURECTOMY

KW - PHASE-II TRIAL

KW - EXTRAPLEURAL PNEUMONECTOMY

KW - TRIMODALITY THERAPY

KW - LUNG-CANCER

KW - SURGICAL-MANAGEMENT

KW - INTERNATIONAL-ASSOCIATION

KW - EUROPEAN-ORGANIZATION

KW - PROGNOSTIC-FACTORS

KW - MULTICENTER TRIAL

U2 - 10.1016/j.lungcan.2014.01.021

DO - 10.1016/j.lungcan.2014.01.021

M3 - Literature review

SN - 0169-5002

VL - 84

SP - 103

EP - 109

JO - Lung Cancer

JF - Lung Cancer

IS - 2

ER -