Official reprint from UpToDate
Daniel H Sterman, MD
Leslie A Litzky, MD
Larry R Kaiser, MD
Steven M Albelda, MD
Arthur T Skarin, MD
Michael E Ross, MD
Treatment approaches for localized malignant pleural
mesothelioma and solitary fibrous tumor of the pleura
Last literature review version 18.1:
Ocak 2010 |
This topic last updated:
Ocak 4, 2010
— Malignant mesothelioma is a rare neoplasm that typically arises from the
mesothelial surfaces of the pleural cavity. Mesotheliomas may also arise from the peritoneal
surface, the tunica vaginalis, or pericardium. (See
"Malignant peritoneal mesothelioma"
"Testicular sex cord stromal tumors"
Pleural mesothelioma has a poor prognosis. The median survival of patients with mesothelioma is
between 6 and 18 months, and the outlook has not been substantially affected by newer
therapeutic interventions. However, carefully selected patients with localized disease who receive
aggressive multimodality therapy may be long term survivors. (See
diagnosis, and staging of malignant pleural mesothelioma", section on 'Clinical course'
There are only very limited data from randomized trials for patients with disease confined to one
hemithorax. Local treatment approaches for malignant pleural mesothelioma and for fibrous
tumors of the pleura are reviewed here.
Other topics on mesothelioma include:
"Epidemiology of malignant mesothelioma"
"Pathology of malignant mesothelioma"
Clinical presentation and staging (see
"Clinical presentation, diagnosis, and staging of
malignant pleural mesothelioma"
Systemic treatment of advanced disease (see
"Systemic treatment approaches for unresectable
— There is not a single best or standard approach for patients with
malignant pleural mesothelioma, and treatment may range from simple tube thoracostomy with
talc pleurodesis to control a pleural effusion to radical surgical approaches. Operation may be part
of the initial treatment for carefully selected patients, either alone or in combination with other
modalities. However, no randomized trials exist that have demonstrated a survival benefit for
surgical resection, although a number of observational trials have suggested such a benefit. One
pilot trial conducted in the United Kingdom (the MARS trial) has at least demonstrated the
feasibility of randomizing patients to radical surgery or to nonsurgical therapy [
— Operation for malignant pleural mesothelioma can be done simply for diagnostic or
palliative purposes, but in selected patients, it may be done with curative intent. Although
potentially associated with substantial morbidity, resection may be useful to palliate the major
symptoms of the disease, which include pain and dyspnea. Whether resection actually is
responsible for an improvement in survival in some patients remains uncertain due to the lack of a