02 - Treatment approaches for localized malignant pleural...

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Official reprint from UpToDate ® www.uptodate.com ©2010 UpToDate ® Authors Daniel H Sterman, MD Leslie A Litzky, MD Larry R Kaiser, MD Steven M Albelda, MD Section Editor Arthur T Skarin, MD Deputy Editor 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 INTRODUCTION — 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" and "Testicular sex cord stromal tumors" and "Cardiac 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 "Clinical presentation, 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 (see "Epidemiology of malignant mesothelioma" ) Pathology (see "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 malignant mesothelioma" ) PLEURAL MESOTHELIOMA — 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 [ 1 ]. Surgery — 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
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02 - Treatment approaches for localized malignant pleural...

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