Progress in the management of malignant pleural mesothelioma

The incidence of malignant pleural mesothelioma is likely to increase over the next 10-20 years. Although relatively uncommon, it represents a challenge due to still unsatisfatory prognosis. Once diagnosis is made, many years after asbestos exposure, malignant pleural mesothelioma usually tends to remain confined to the hemithorax. However, the locoregional extent of disease is wide and curative resection is feasible very seldom. Moreover, the role of both local treatment modalities (surgery and radiotherapy) is unsettled definitely. Chemotherapy has been disappointing for years. However, very recently it has shown promising activity with the use of new generation antimetabolities. Although each single therapeutic modality has limited value, a combined approach may improve survival and quality of life. This overview is aiming to present current views on the use of different modalities in the treatment of malignant pleural mesothelioma, in particular their integration within combined management.